Final Defendant in Health Care Fraud Case Sentenced to 1 Year in Federal Prison

A 51-year-old defendant was the last in a line of individuals who were indicted by the federal government for health care fraud. The defendant was sentenced to 1 year in federal prison and required to repay $547,560 as part of the agreement. His sentence will be followed by three years of supervised release. According to the lawsuit, he was part of a group that billed Blue Cross and Blue Shield for more than $53 million in fake claims including allergy tests and physical therapy that patients never received.

Healthcare fraud is a sprawling business. Defendants, in these cases, are accused of making false claims to insurance companies. In most cases, the patients aren’t aware of what is going on and don’t receive bills related to the phony services. Insurance companies end up footing the bill and it drives up the cost of healthcare for everyone.

What happened? 

According to the lawsuit, the defendants opened multiple clinics throughout South Florida and paid recruiters to provide personal information about Blue Cross and Blue Shield recipients. The defendants then submitted fraudulent billing information to the insurer receiving payments into the company’s bank account. The money was then divided up into multiple personal bank accounts and laundered, according to federal authorities.

The alleged ringleader of the operation was sentenced to 52 months in federal prison for his role in bilking Blue Cross and Blue Shield of insurance claims.

Healthcare fraud 

Title 18 of the United States Code Section 1347 makes it unlawful to file a false or fraudulent claim with a health care insurance provider. The state must be able to establish that the defendant knowingly defrauded an insurance carrier. As with all fraud charges, establishing an intent to defraud is the primary goal of the prosecution. The prosecution accomplishes this by showing an intent to defraud when they use false pretenses, misrepresentations, or false promises to obtain money from the insurance carrier. Healthcare insurance companies lose billions annually to healthcare fraud.

Generally speaking, sentences can vary widely in a healthcare fraud prosecution. Typically, the amount of time spent in prison is related to the sophistication of the scheme, the amount of money stolen, and/or the number of victims. In the case mentioned above, the plaintiffs bilked Blue Cross and Blue Shield of over $53 million in proceeds by filing false claims on patients’ insurance policies. The government was able to establish that the patients never received services from the healthcare clinics. Hence, everyone associated with the scheme was charged with fraud and pleaded guilty to the charges.

Talk to a Tampa, FL Federal Defense Lawyer Today 

If you have been charged with fraud, call the Tampa criminal lawyers at The Matassini Law Firm today. We can help you fight the charges and prepare a vigorous defense on your behalf.

Source:

justice.gov/usao-sdfl/pr/final-defendant-sentenced-federal-prison-12-defendant-53-million-health-care-fraud