Investigation into Medicare Fraud Claims

PHILADELPHIA – An investigative team has begun looking into alarming claims raised by two viewers after they received questionable benefit notices from Medicare.

Jacob Cohen mentioned he meticulously reviews his benefits statements. Through this process, he found charges for services and equipment that he never ordered or even knew about.

The billing company, Sunshine Senior Solutions, is reportedly under scrutiny from several health networks, including Medicare itself. “It’s taxpayer money that impacts all of us,” Cohen stated.

Cohen detailed that nearly $9,000 worth of claims for catheters and other supplies had been submitted from September 2024 to January of this year.

“I contacted Medicare and said, ‘That’s not me. I didn’t order these supplies. I suspect it’s Medicare fraud,’” he explained.

Similarly, James Dente echoed Cohen’s worries, saying he had received no prior communication about charges that seemed fraudulent. He noted that his Medicare account also had dubious activities, including a billing of $21,000 for catheters and equipment that he did not order.

Dente reached out to the Medicare Fraud Hotline mentioned in his notice to flag these improper payments.

“They informed me that this company is under investigation,” he recalled.

Sunshine Senior Solutions, based in Delray Beach, Florida, has already been alerted by UC Health in Colorado regarding the suspicious charges.

Corporate records indicate Mikhail Tabidze as the current owner, but attempts to reach him were fruitless. Interestingly, investigators found that Dana Pessoa owned the company during the time when Cohen and Dente observed questionable charges.

When contacted, Pessoa denied any connection to the fraudulent claims and mentioned that she sold the business late last year. Although she referred the inquiry to an attorney, there was no feedback from that end.

Furthermore, Pessoa acknowledged being the girlfriend of Victor Van Vickory, who is currently serving a seven-year sentence for an unrelated Medicare fraud case involving millions in taxpayer losses.

Dente expressed frustration with Medicare’s slow response, stating, “They indicated it could take years for an investigation into this company to conclude.” Earlier in the year, Medicare had notified Dente that her account number was compromised, resulting in the issuance of a new number. She is upset that the investigation into the misuse of taxpayer funds doesn’t seem to be prioritized.

Even after reporting the first suspicious claim, Medicare processed a second claim from Sunshine Senior Solutions, prompting Dente to question the oversight process.

“Isn’t there a system that raises a red flag to stop further claims from Sunshine Solutions?” he asked.

The Centers for Medicare and Medicaid Services stated it removed Sunshine Senior Solutions from its program in June but mentioned that investigations are often intricate and require thorough legal and factual analysis across various departments.

Seniors who believe they have been incorrectly billed by Sunshine Senior Solutions are encouraged to contact Medicare. Experts advise treating your Medicare number with the same caution as a credit card. If you receive unsolicited requests for personal information, it’s best to hang up and check your statements.