Florida’s notoriety as the U.S. Medicare fraud capital was recently burnished more by what feds are calling the country’s largest medical fraud takedown — more than half the uncovered $6.5 billion in fraud was Florida-related.
The 2026 National Health Care Fraud Takedown announced June 23, 2026 snared 455 defendants in 45 U.S. states and territories. The Florida cases, however, prove that Florida goes bigger and more byzantine than most when it comes to health care fraud.
- The case against one Miami man, Ibrahim Khaldoon Hilmi, 58, points to more than half the total fraud uncovered in the nationwide crackdown: he was part of a plan to make $3.7 billion in false claims to Medicare, Medicaid and other insurers.
- Another involved an allegation that a Miami man impersonated his deceased doctor-uncle to certify patient disabilities so that citizenship applicants could get out of required tests.
- Another case accuses the medical director of a Boca Raton company for fraudulently submitting claims to insurers for fake cardiovascular tests after one student, who had been cleared by the company to play, died while exercising with his basketball team.
Most of them, though, involve fraud like the kind that Dick Natalizio, 90, of Palm Beach Gardens discovered quite by accident: durable medical equipment fraud.
“I get a notice from my (Medicare insurance) supplement saying, ‘After this charge, you will be this much (closer) to
your deductible.’ … I was thinking, ‘What the heck is this … ’” said Natalizio, who is retired from running a Wisconsin insurance and risk management firm.
Medicare, he said, “authorized $3,200 for knee braces.”
Natalizio called Medicare’s administration to report it.
“I said, ‘You could jump on this one right away. I didn’t get the knee braces,’” he said, recounting how the person answering the phone said it would be referred to the correct department. “ … And that was the end of it.”
What is Trump’s plan for Medicare, Medicaid?
The clock is ticking toward the end of Medicare and Medicaid as it is known to the 150 million Americans covered by the two programs. Together with other federal health expenses, Medicare and Medicaid accounted for the biggest chunk of government spending in 2024, just ahead of Social Security, according to the Committee for a Responsible Federal Budget.
Starting in 2027, Medicaid recipients will be required to put in 80 hours each month, either in jobs or qualifying community service.
As for Medicare, the latest report from Medicare trustees, issued June 9, 2026, moved the depletion date for the Medicare Trust Fund three months earlier than the previous year's report. If Congress does nothing, payments to providers may have to be cut by 11% in the second quarter of 2033, according to some analyses.
More immediately, President Donald Trump’s administration announced July 28 that a program that sent $3.6 billion to subsidize Medicare drug prescription plans this year will end, according to reporting in the Wall Street Journal. Medicare recipients will learn what this end of this program, instituted under President Joe Biden, will mean to them when the next enrollment period rolls around in November.
“We are stabilizing the market so this bailout is no longer needed,” said Mehmet Oz, the administrator of the Centers for Medicare and Medicaid Services, in a July 28 post on social media.
Ostensibly, however, President Trump has stated that his administration would leave Medicare and Medicaid benefits untouched, except for rooting out waste, fraud and abuse. At the first cabinet meeting of his second administration on Feb. 26, 2025 after Congress passed the initial budget resolution that would become the One Big Beautiful Bill Act, Trump was asked if $2 trillion in cuts would mean cuts to the biggest items in the federal budget, Social Security, Medicare and Medicaid.
“I have said it so many times, you shouldn't be asking me that question,” Trump said. “We’re not going to touch it … Now we are going to be looking for fraud … I’m sure you’re OK with that.”
Can rooting out fraud save Medicare and Medicaid?
The short answer is no, according to Evan Saltzman, a Florida State University professor in the Department of Risk Management/Insurance, Real Estate and Legal Studies.
“I have no doubt there's waste, fraud, and abuse … but are we going to solve our budgetary problems by cracking down on waste, fraud and abuse? I highly doubt it,” said Saltzman, whose research focuses on the optimal design of health insurance markets.
At least, in the case of Hilmi, accused of fraudulently billing $3.7 billion in medical claims, online complaints about being billed for equipment never received prompted him to leave the country, according to court papers.
Weeding out $6.5 billion in fraud might buy Medicare a few extra months, Saltzman said. But tougher choices will soon have to be made.
“When you start talking about major cost savings ... it may require fundamental changes of the program — charging higher premiums or providing fewer services,” he said.
What is the most common Medicare fraud?
The catalog of allegations in the June 23, 2026 fraud takedown announcement is an extensive list of care and equipment billed to Medicare, but not provided. Sometimes the owners of the identification numbers knew about it, sometimes they didn’t.
A Sarasota nurse who was part of the nationwide health care fraud crackdown texted her co-conspirators about going “room to room” looking for wounds so she could order pricey skin patches on behalf of patients. Medicare was billed $118 million for wound care over 18 months by that practice.
Mark Cooper, an attorney who spent his working years in Fort Myers before retiring to upstate New York, has found he’s had urinary catheters and diabetes equipment ordered in his name from a doctor in Austin, Texas. He noticed it in his explanation of benefits for claims processed in December 2025.
“I have never been to Austin, Texas,” Cooper said. “I have never used a catheter.”
That followed some diabetes supplies that showed up on his statements about two years ago.
Reporting it to Medicare took three hours compared to the five minutes it took to resolve it with his insurance company, Cooper said.
Why it can’t be more efficient like the credit card companies have become puzzles Cooper.
“Send me a text: ‘Did you get urinary catheters out of Austin, Texas?’ and I’ll say ‘no,’” Cooper said. “Just like your credit card company will say, "Did you just spend $20,000 on comic books in Hong Kong? You just say no. It seems to be, in this day and age, a simple thing to do.”
The Centers for Medicare and Medicaid Services estimates that it processes 1.1 billion claims every year and about 3 million every day. Ensuring each claim is not fraudulent could delay needed care, but the government has started employing artificial intelligence to flag suspicious patterns. That incited protest.
Can Medicare and Medicaid beneficiaries stop fraud?
The U.S. Department of Health and Human Services Office of Inspector General has put out alerts noting the varieties of fraudulent schemes that involve catheters, diabetes equipment, cardiovascular testing and fraudsters impersonating government officials.
Tips to guard against fraud include:
∎ Protect your personal information — no one except your provider’s office should ever ask for your medical insurance patient number.
∎ Check medical bills and statements and report questionable charges or fraud.
∎ Beware of callers making a variety of claims about your eligibility for a government program or grant. Recipients are advised to hang up immediately.
∎ If medical equipment is delivered to you, don't accept it unless it was ordered by your physician. Keep a record of the sender's name and the date you returned the items.
Report suspicious activity by calling 1-800-HHS-TIPS (800-447-8477), or going online at oig.hhs.gov/fraud/hotline or another law enforcement agency.
Anne Geggis is statewide reporter for the USA TODAY NETWORK FLORIDA, reporting on health and senior issues. If you have news tips, please send them to ageggis@usatodayco.com. You can get all of Florida’s best content directly in your inbox each weekday by signing up for the free newsletter, Florida TODAY, at https://palmbeachpost.com/newsletters.
This article originally appeared on Sarasota Herald-Tribune: Why you could be a part of medical fraud and not even be aware of it
