Recently in Medicare Fraud Category

April 9, 2013

Medicare Fraud Case Lands Three Family Members in Prison

Last Friday, in a federal courtroom packed with spectators and family members, a federal judge handed down lengthy prison sentences to three family members who were previously found guilty for their involvement in a multi-million Medicare fraud scheme. Antonio Macli, his son Jorge Macli, and his daughter Sandra Huarte, were all sentenced for their participation in healthcare fraud allegedly being committed at their clinic referred to as Biscayne Milieu. All three defendants appeared with their Miami criminal defense lawyers at the sentencing hearing. The defendants had been previously convicted by a jury in the Southern District of Florida.

U.S. District Judge Robert Scola handed down heavy sentences for the three defendants for running a Medicare fraud scam that received $11 million from the federally funded healthcare system. The patriarch of the family, Antonio Macli, received a thirty year sentence for his actions as the clinic owner. His son, Jorge Macli, received a 25 year sentence for his action s as the company's operating officer. Macli's daughter, Sandra Huarte received a 22 year sentence for her actions as the bookkeeper of the clinic. After Judge Scola pronounced the sentence, he told the defendants that their crime was committed in the healthcare fraud capital and that the scheme was multifaceted and complex. The judge was disturbed by the fact the defendants used vulnerable patients with substance abuse problems to line their own pockets.

In the summer of 2012, the defendants went to trial in an effort to be absolved from a healthcare fraud that billed Medicare an estimated $57 million. The bills submitted to Medicare were for mental health services that were not provided, or were provided, but needed. According to prosecutors, the scam occurred between 2007 and 2011. During that time, the clinic purportedly treated 1,100 patients supposedly diagnosed with mental disorders such as schizophrenia and bi-polar disorders. Five other individuals were convicted at the jury trial, including the clinic's medical director. The 72 year-old psychiatrist from Plantation, Florida received a 12 month prison sentence. Twenty other people were charged for their involvement in the fraud, all of which entered guilty pleas to limit their exposure.

Each of the Miami defense attorneys representing the defendants minimized their client's involvement in the Medicare fraud scheme. Despite the statements made on the defendants' behalf, Judge Scola lowered the boom on all three. After hearing evidence over a two month period, which involved testimony regarding the inner workings of the fraud and the kickbacks that were being paid to patient recruiters, the judge handed down a sentence that could be considered heavy-handed to some. Anyone being investigated by the federal authorities for Medicare fraud or anyone having already arrested charged for Medicare fraud should seek counsel with experience in federal court defending Medicare and healthcare fraud related cases.

3 Miami-Dade Family Members Get Long Prison Terms in Multi-Million Dollar Medicare Fraud Case, Miami Herald.com, April 5, 2013.

November 20, 2012

Federal Judge Sentences Patient Recruiters

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.

May 7, 2012

Multiple Medicare Fraud Busts Across the Country

Doctors, nurses and social workers were all arrested by federal authorities in seven cities around the country for their alleged involvement in unrelated Medicare fraud schemes. The Medicare fraud amounted to billing in excess of $452 million. It is the single largest Medicare fraud bust orchestrated by the federal authorities to date. Federal investigators and prosecutors are still trying to curb a problem that costs taxpayers an estimated $60 billion to $90 billion per year. Since 2009, Health and Human Services has thrown a countless a mount of money and man hours to fighting what they believe is a systemic problem. Just when it appears the number of prosecutions on Medicare fraud cases may be subsiding, the feds make a nationwide bust. Criminal lawyers either privately retained or supplied by the federal public defenders' offices will represent the 107 defendants arrested in seven cities around the country.

It is no surprise that the arrests came out of Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Baton Rouge. These cities have long been considered the hotbeds for Medicare fraud. Two individuals arrested out of Baton Rouge operated community mental health centers. The centers would recruit elderly people and those with mental health and drug addiction issues. The clinics billed $225 million for treatments that were unnecessary or never provided. The indictment not only addresses the massive fraud, but also efforts of the owners of the centers to destroy incriminating documents. Once their operations were shut down, it is alleged that they tried to sell their patients to other clinics and medical centers. Five other people from Baton Rouge were also arrested for their involvement. The arrests came after a six year investigation conducted by federal authorities.

Miami is home to more than 50 defendants that were also arrested for fraud. The grand total of the fraud was alleged to have exceeded $136 million. The defendants arrested were not all part of the same scheme to defraud, but were all alleged to have been involved in community healthcare centers and home health care operations. According to investigators, the latest trend in Medicare fraud involves community mental healthcare centers. The centers have become popular schemes as individuals involved in Medicare fraud move away from the more common HIV treatments, medical equipment businesses and home healthcare. Federal investigators have been trying to keep up with the evolution of the federal healthcare fraud.

Individuals charged with healthcare fraud are facing serious consequences, months or even years in prison. While the offense of fraud is serious, the poignant problem is the sharp escalation under the federal sentencing guidelines that results from the large amounts of losses suffered by the federal government as a result of the fraud. Losses in excess of a million dollars can certainly land someone in the federal prison from 8 to 10 years. Any reductions in sentencing will only be afforded those who agree to cooperate with the government. Cooperating with the government includes providing information against others committing fraud and possibility of testifying against co-defendants at trial.

107 Charged in Medicare Fraud Busts in 7 Cities, CBSNews.com, May 7, 2012.