Florida Man Pleads Guilty in $200 Million Medicare Fraud Scheme
Federal prosecutors recently accepted the guilty plea of a Miami area man for his role in two fraud schemes that led to more than $200 million in fraudulent claims submitted to Medicare. According to a report by IFAwebnews.com, Nelson Fernandez pleaded to one count of conspiracy to commit healthcare fraud and one count of conspiracy to defraud the United States and to pay and receive illegal healthcare kickbacks.
The Medicare fraud scheme involved two providers, American Therapeutic Corporation (ATC), a company that owned and operated partial hospitalization programs throughout South Florida, and American Sleep Institute (ASI), an entity that provided diagnostic sleep disorder testing. According to court records, ATC paid kickbacks to assisted living facilities, halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI.
Fernandez admitted to federal prosecutors that he was a patient broker who provided patients to ATC and ASI in exchange for checks and cash. His payments were based on the number of days each patient spent at ATC. Fernandez also admitted that he worked with others in submitting fraudulent billings to Medicare through a home health services company, Priority Home Health. His sentencing is scheduled for January 17, 2012, and he faces up to 15 years in prison and a $250,000 fine.
Prosecutors generally have discretion in how they charge Medicare fraud defendants, and the presumptive sentences largely depend on the losses involved and the defendant's criminal history. While all cases are different, a person charged with taking more than $1 million generally faces prison time.
A 2008 OMB report indicated that $10 billion in improper Medicare benefits were paid in 2007, with $23.7 in fraudulent payments made overall. With dwindling government resources and rising deficits, healthcare fraud has grown as a target for federal prosecutors. The Department of Justice, the Department of Health and Human Services (HHS,) and other government agencies developed a Medicare Fraud Strike Force set on combating fraud in eight cities across the country. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius recently announced charges levied against 91 defendants, including doctors, nurses and other medical professionals for their roles in $295 million in fraudulent Medicare billing.
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