Seniors say Medicare accounts fraudulently billed for thousands of dollars | Investigation

PHILADELPHIA (WPVI) -- The Action News Investigative Team has been looking into questionable billing raised by two viewers. It comes after they received benefit notices from Medicare that raised red flags.

Jacob Cohen said he goes over his explanation of benefit statements religiously. He said that is how he found charges for services and equipment that they say their doctors did not order.

The company named on the bill, Sunshine Senior Solutions, has now been flagged by some health networks, including Medicare.

"It's taxpayer money that affects all of us," said Cohen.

Cohen said the charges were for nearly $9,000 for catheters and other supplies billed from September 2024 until January of this year.

"I spoke to Medicare after I found it, and said, 'It's not me. I didn't order these supplies, and I believe it's Medicare fraud,'" he said.

"I never had that never received any of those things. So knew that was all bogus," added James Dente.

Dente said he, too, had the same suspicious activity on his Medicare account. Twenty-one thousand dollars was billed for catheters and other equipment that his doctor did not order.

He also called the Medicare fraud hotline listed on the notice, questioning the improper payments.

"They would tell me was this company is under investigation," he said.

Sunshine Senior Solutions, located in Delray Beach, Florida, has been flagged by UC Health in Colorado for suspicious charges and potential fraud.

Florida Corporate records show the current owner of record is Mikheil Tabidze. Attempts to reach him were unsuccessful.

But the Investigative Team dug into Florida corporate records and found Dana Pessoa was an owner when some of Cohen and Dente's questionable billing occurred.

Reached by phone, she insists she was not involved in any fraudulent billing and pointed out that late last year, she sold the company.

Pessoa referred us to an attorney who didn't return multiple calls for comment.

She also admitted that she was the girlfriend of Victor Van Vickory, who is serving seven years in federal prison on an unrelated Medicare fraud scheme that cost taxpayers millions of dollars.

"It certainly seems like Medicare is going very slow," added Dente. "They said this could be years of investigating this company before they come to any conclusion."

Dente said earlier this year, Medicare informed him his account number was compromised and issued him a new one. He is angry that there is not more urgency in investigating the waste of taxpayer money.

He said even after he reported the first set of questionable charges by Sunshine Senior Solutions, Medicare paid out a second claim.

He questions why.

"Don't you have a red flag system that puts up a red flag and let them know, 'Hey, we're not processing any more claims from Sunshine Solutions?" he asked.

The Centers for Medicare and Medicaid Services would only tell us that it barred Sunshine Senior Solutions from the Medicare program in June.

In a statement, the agency also said fraud investigations are complex and require extensive fact-finding and legal reviews across agencies.

Seniors who suspect they may have been wrongfully billed by Sunshine Senior Solutions should reach out to Medicare.

Experts said to treat your Medicare number like a credit card, hang up if you receive unsolicited calls for personal information, and check your statements.