SAN JUAN, Puerto Rico – The United States Attorney for the District of Puerto Rico, W. Stephen Muldrow, the Special Agent in Charge (SAC) of the San Juan Office of the Federal Bureau of Investigation (FBI), Joseph González, and the Assistant Special Agent in Charge (ASAC) of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), José Luis Soto, are redoubling efforts and focus to investigate, detect, and deter Medicare fraud.
According to estimates from the National Health Care Anti-Fraud Association, Medicare fraud costs taxpayers over $100 billion a year in a wide range of fraud schemes that involve beneficiaries, health care providers, and organizations operating Medicare Advantage (Medicare Part C) plans. All Medicare beneficiaries in Puerto Rico, as well as the doctors and other healthcare providers who serve those beneficiaries, deserve an affordable, effective, efficient, and transparent health care system.
“Typical fraud schemes committed in the health care area include cases where healthcare providers bill for services not actually provided or lie about and inflate the nature of the actual services rendered (known as “upcoding”). However, together with our law enforcement partners, our investigative and prosecutorial focus will continue to look to any fraudulent activities occurring within organizations managing Medicare Advantage programs, including payments of illegal incentives and the submission of false information related to patient risk assessments,” said United States Attorney Muldrow.
“Healthcare is a basic need and improper use of healthcare systems can turn this basic necessity into a luxury,” said Special Agent in Charge of the FBI San Juan Field Office, Joseph González. “The FBI will not stand by while this type of abuse is taking place. We ask that anyone who believes they have been a victim or witness to a healthcare fraud scheme to report it by calling the FBI San Juan number 787-987-6500 or leave a tip online through tips.FBI.gov. The people can rest assured that we will follow each lead and investigate each case to its ultimate consequence.”
ASAC José Luis Soto of the HHS-OIG Puerto Rico Field Office said, “HHS-OIG will continue to investigate any conduct by Medicare Advantage plans that may result in violation of federal law and will work jointly with our law enforcement partners to ensure that entities that execute business with federal health care programs do so in an honest manner.”
What can you do?
Please contact the FBI and HHS-OIG hotlines below to provide information and leads of any fraud scheme concerning Medicare funds. Such fraud schemes include but are not limited to: billing for services that are not provided, billing for more expensive services than were actually provided, also known as “upcoding”, fraudulent attempts to tamper with patient risk factors or providing incentives to undergo medical testing or procedures that are not medically necessary.
HHS-OIG Email: email@example.com
HHS-OIG Telephone: 787-758-3752
FBI tips online: tips.FBI.gov
FBI Telephone: 787-987-6500
Public media complaints: