Find Corporate Waste

Tag: Florida

  • Complete Health Pays $14.1M Over Inflated Medicare Advantage Diagnoses

    Complete Health Pays $14.1M Over Inflated Medicare Advantage Diagnoses

    Complete Health Partners Holdings will pay $14.1 million to settle allegations that it used unsupported patient diagnoses to increase Medicare Advantage payments.

    The Jacksonville, Florida-based company manages and operates affiliated medical groups in Florida, Alabama and Colorado.

    Under its contracts with Medicare Advantage insurers, Complete Health received a percentage of the payments those insurers collected from the Centers for Medicare & Medicaid Services. Because CMS pays more for patients coded as having serious medical conditions, Complete Health stood to profit when patient risk scores increased.

    According to the Justice Department⁠, Complete Health submitted unsupported diagnoses between 2020 and 2023 involving drug and alcohol dependence, major depression, bipolar disorder and paranoid disorders.

    Federal officials alleged that the company distributed incorrect coding guidance, searched medical records for additional diagnoses and prompted physicians to add conditions that were not clinically justified or properly supported.

    Those diagnoses increased payments from CMS to Medicare Advantage insurers. The insurers then passed part of the additional money to Complete Health.

    The case was brought under the False Claims Act by Karen Bowers, a former associate director of risk adjustment at VIVA Health. Bowers will receive approximately $2.47 million from the federal recovery.

    The settlement shows why insiders remain critical to exposing Medicare Advantage fraud. Employees who understand coding guidance, physician prompts, risk-adjustment reviews and payment arrangements may be able to identify when patient conditions are being exaggerated to extract more taxpayer money.

  • $89 Million Payroll Fraud Scheme Exposes a Taxpayer-Theft Pipeline

    $89 Million Payroll Fraud Scheme Exposes a Taxpayer-Theft Pipeline

    The IRS announced that Mario Flores, a Honduran national, was sentenced to 96 months in prison for his role in an off-the-books payroll scheme tied to the construction industry based in Orlando, FL.

    The sentencing record shows the scale. Flores received eight years in prison. Co-conspirator Iris Villafranca was previously sentenced to 17 years, ordered to pay more than $38 million in restitution, and ordered to forfeit $89 million in criminal proceeds.

    According to the IRS Criminal Investigation⁠, Flores and his co-conspirators used shell companies to cash approximately $89 million in checks from construction subcontractors between 2015 and 2022.

    The scheme converted contractor checks into cash so workers could be paid off the books. That structure helped contractors avoid payroll taxes, falsify tax filings, and conceal the true size of their workforce.

    This was not just illegal hiring. It was a fraud model. Through this scheme, The United States lost more than $38 million.

    Off-the-books payroll gives dishonest contractors an artificial advantage over lawful employers. They avoid taxes, insurance costs, reporting duties, and worker-authorization rules while competitors are forced to comply.

    The scheme also targeted workers’ compensation insurance. Prosecutors said the conspirators leased insurance certificates to contractors and submitted false information about the number of workers covered and the amount they were paid.

    Payroll fraud shifts risk onto taxpayers, insurers, injured workers, and honest businesses.

    For Find Corporate Waste, the relevance is the fraud architecture. Shell companies, false filings, subcontractor pass-throughs, cash payroll, and insurance misrepresentations are not isolated paperwork issues. They are vital data signals.

    Eligibility must be testable and traceable, such that disqualifying facts can be presented to trigger recovery through qui tam proceedings.

    The underground economy drains public revenue, rewards unlawful contractors, and forces taxpayers to subsidize businesses that refuse to follow the rules.

    Find Corporate Waste is here to track every lead and to provide assistance to federal partners in addressing the systematic fraud issue that has plagued our country for far too long.

  • Contractors to Pay $3.6M Over False Veteran-Owned Small Business Certification

    Contractors to Pay $3.6M Over False Veteran-Owned Small Business Certification

    Two government contractors agreed to pay more than $3.6 million to resolve allegations involving False Claims Act and Contract Disputes Act liability tied to federal set-aside contracts, according to the DOJ.

    The settlement involves Officium Global LLC and Loyal Source Government Services LLC. Prosecutors said Officium Global allegedly submitted false or fraudulent claims for payment on seven service-disabled veteran-owned small business set-aside contracts awarded between May 2017 and June 2018.

    According to the settlement agreement, Officium Global was allegedly not entitled to those contracts because its management and daily business operations were not controlled by a service-disabled veteran. The DOJ said the company submitted, or caused to be submitted, false certifications and statements representing that it met all requirements to be a service-disabled veteran-owned small business when it did not.

    Officium Global will pay more than $1.8 million to resolve the False Claims Act allegations. Loyal Source Government Services will separately pay more than $1.8 million to resolve Contract Disputes Act allegations tied to alleged breaches of the same seven contracts.

    The case began as a qui tam lawsuit filed by relator Jeremy Lavin in the Middle District of Florida. Under the False Claims Act, private citizens may sue on behalf of the United States and share in the recovery.

    The DOJ said Lavin will receive more than $680,000 from the settlement proceeds.

    The case is United States ex rel. Lavin v. Loyal Source Government Services, LLC et al., No. 6:19-cv-958, in the U.S. District Court for the Middle District of Florida. 

    Find Corporate Waste tracks False Claims Act recoveries involving government contracting fraud, small-business set-asides, and eligibility certifications. Anyone with inside knowledge of set-aside control failures, pass-through contracting arrangements, or false small-business certifications may have information relevant to public-fraud enforcement.