BROOKSVILLE, Fla. — Florida has emerged as a prime target for Medicare fraud schemes driven by stolen identities, with criminals harvesting personal data from data breaches and scams to submit billions of dollars in fraudulent claims.
How criminals steal identities
Dr. David Maimon, who directs the Evidence-Based Cybersecurity Research Group at Georgia State University, said most identity theft cases originate in similar ways.
"Identities come from two key sources — the first, data breaches," Maimon said.
The second method involves scams targeting seniors directly.
"Like the fake phone calls from Medicare or from the government. They will send you fake text messages," Maimon said.
Some fraudsters even use postcards in the mail, trying to trick seniors into calling a number or logging onto a website and giving up their personal information and Medicare ID numbers.
Dark web marketplace for stolen data
Maimon received text messages from a business he contacted after seeing ads offering personal data for sale on the dark web.
The profile packages offered for sale included names, Social Security numbers, phone numbers, dates of birth, and Medicare numbers — at a cost of just $10 each.
"If you buy like 1,000 identities, you can get the same deal for like $8," Maimon said.
Maimon recently issued a report called "How Floridian Identities Are Being Used to Fuel Medicare Fraud," in which he describes "the large-scale harvesting, sale, and reuse of beneficiary identities," which are used to "extract taxpayer dollars at scale."
"We're seeing more and more reports of victims… people from Florida... looking at their Medicare statements and realizing many transactions there aren't theirs," Maimon said.
Maimon also confirmed the problem is accelerating.
"We are seeing dramatic increase in the volume of reports coming from Florida," Maimon said.
Florida company owner charged with money laundering
The owner of Sunshine Senior Solutions in Delray Beach, Florida, was charged in January with conspiracy to commit money laundering.
Nika Machutatdze, a Russian national identified in Sunbiz documents as an authorized member of the company, is accused of submitting fraudulent claims through two companies he owns.
The complaint alleges the two companies "fraudulently billed Medicare" and supplemental insurance "billions of dollars for orthotic braces, continuous glucose monitors, urinary catheters, and wound dressings that beneficiaries did not need and did not receive."
One Florida senior was among the victims.
"I did not order. Did not receive. Never heard of the doctor whose name was on it," the victim said.
She was among dozens of patients nationwide who complained to sister station WPTV in West Palm Beach about fraudulent billing linked to the company in the months before the owner was charged.
Some seniors previously reported they received items like knee braces or compounded creams they never ordered from other companies — with Medicare footing the bill.
Data breach exposed 153,000 patients
Maimon's report references a breach of Retina Group of Florida, an ophthalmology practice with 20 locations, including an office in Brooksville.
Sensitive information from 153,000 patients was compromised in that breach.
According to the report, a 76-year-old man from Spring Hill and an 81-year-old Brooksville resident were among those whose personal information was sold on the dark web.
Not only were their Medicare accounts billed for services they never received, but Maimon also says their personal information was used to apply for a credit card, obtain a phone line, and even open a new bank account.
The medical practice notified customers of the breach last August and offered patients credit monitoring and identity theft protection services for 12 months.
Federal authorities struggling to keep up
The problem has grown so severe that the administrator for the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, says federal authorities cannot keep up with all the fraud.
"They never even ship out anything to anybody. When they open a bank account, there's no payroll, there's no inventory because they're not real businesses," Oz said.
What you can do
Dr. Oz and Maimon encourage Medicare recipients and their families to check statements regularly and report suspected fraud immediately.
"Be vigilant about this. Look at statements you get, look at suspicious mail you get to your place," Maimon said.
If you suspect your Medicare account has been fraudulently billed, call 1-800-Medicare (1-800-633-4227) or report it online using the Office of Inspector General Fraud Reporting Tool.
Share Your Story with Adam
Adam Walser has spent more than a decade fighting for what’s right in Tampa Bay as part of the I-Team. He’s helped expose flaws in Florida’s eldercare system and held leaders accountable for questionable HOA practices. Reach out to Adam with any issue you think he needs to investigate.
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