A federal judge in the Southern District of Florida sentenced two defendants for their involvement in a medicare fraud case. Both defendants were patient recruiters that worked for mental health clinic called Biscayne Milieu Heath Care Inc. According to prosecutors, the defendants were involved in a healthcare scheme to defraud which billed Medicare in excess of $50 million. Both defendants appeared with their Miami criminal attorneys at the sentencing hearing. Anthony Roberts was sentenced by the federal judge to 87 months in prison and ordered to pay approximately $900,000 in restitution. Derek Alexander received a 42 month prison sentence and was ordered to pay a little over $300,000 in restitution. Both defendants took their cases to trial and were convicted by a jury for conspiracy to commit a healthcare fraud and for receiving kickbacks.
These two defendants were only small fraction of individuals prosecuted for their involvement in Medicare fraud committed at Biscayne Milieu. Owners, managers, doctors, therapists, patient brokers and other employees were among those charged in federal court for the white collar crime of Medicare fraud. The majority of the defendants were charged with healthcare fraud, money laundering and paying and receiving "kickbacks". All of the defendants were prosecuted in one of two indictments which were unsealed in September 2011 and June 2012. To date, 25 members of the scheme to defraud have either entered guilty pleas or have gone to trial. The majority owners and operators of the clinic, as well as a doctor went to trial and were convicted on a multitude of charges. They are scheduled to be sentenced in federal court on December 20, 2012.
To prove the crime of heathcare fraud, Prosecutors involved in the case submitted evidence at trial that the aforementioned perpetrators submitted false claims and bills to Medicare. Biscayne Milieu submitted in excess of $50 million dollars in claims to Medicare. The company operated fictitiously as a partial hospitalization program (PHP) treating individuals with severe mental health illnesses. The owners/operators of the clinic hired recruiters to bring ineligible Medicare beneficiaries for treatment that was never provided. The majority of the people recruited were ineligible for multiple reasons. Some of the recruits were drug users, while other suffered from severe cases of Alzheimers of dimentia. Patients with these issues could not benefit from the treatment they were purportedly receiving at the clinic.
The Medicare Fraud Strike Force continues to investigate and prosecute cases involving healthcare fraud. The strike force is now fully functional in nine cities in the United States. Since the strike force's inception, 1,480 defendants have been charged and prosecuted in federal court. Fraud is not a particularly high offense level under the federal sentencing guidelines. However, it is the amount of loss to the healthcare program that is causing defendants to serve multi-year prison sentences. Of course the sentences are higher if a defendants loses at trial rather than accepting a guilty plea in their case.
Two Patients Recruiters Sentenced in Miami for Roles in $50 Million Medicare Fraud Scheme, FBI.gov, November 16, 2012.