Florida Nurse Convicted for Bilking Medicare out of $200M

A Florida jury convicted a nurse practitioner of health care fraud for the role she played in bilking Medicare of $200 million in a health care fraud scheme. According to the indictment, she signed thousands of orders for orthotic braces and medically unnecessary genetic tests that were all billed to Medicare. In this article, the Tampa, FL federal criminal defense attorneys at The Matassini Law Firm will discuss the concept of health care fraud and how it applies to this case.

Elements of fraud in health care fraud prosecutions 

The fraud scheme targeted Medicare beneficiaries through a telemarketing program designed to get them to request genetic tests and orthotic braces from their doctors. The nurse practitioner signed off on these orders without ever meeting with the patients. In 2020, the nurse practitioner ordered more genetic cancer tests than any other provider in the nation, according to federal authorities. This included oncologists and genetic specialists. She further lied about the nature of the services she provided. She billed Medicare for conducting complex office visits when she never saw the patients in person. In some cases, she submitted claims that she saw patients for more than 24 hours in a single day. The nurse practitioner pocketed $1.6 million for her role in the scheme and purchased cars, expensive jewelry, and other luxury items with the ill-gotten proceeds.

The defendant was convicted of one count of conspiracy to commit healthcare fraud, four counts of healthcare fraud, and three counts of making false statements related to healthcare. She faces a maximum of 20 years in prison on the conspiracy count alone. She also faces 10 years in prison on each count of healthcare fraud and another five years in prison for each count of making false statements regarding healthcare. She faces a maximum of 65 years in prison on the charges.

Billing for unnecessary or unrendered services is a common form of healthcare fraud. In this case, the defendant was convicted of both. She made false statements by claiming that she actually met with patients with whom she never met and billed for office visits that never occurred. She was also found guilty of rendering medically unnecessary services to individuals who did not require genetic cancer tests or orthotic braces.

Fraud is not a crime that you can commit accidentally. Federal authorities are required to prove intent in these cases. They must establish that you made false statements in order to prove the elements of fraud, and that you did so knowingly for financial gain.

Talk to a Tampa, FL Federal Criminal Defense Attorney Today 

The Matassini Law Firm represents the interests of suspects and witnesses in complex fraud cases including healthcare fraud. If you have been investigated or charged with a criminal offense in Tampa, FL, call our office today to schedule an appointment with our board certified criminal trial lawyer and we can begin preparing your defense immediately.

Source:

fiercehealthcare.com/regulatory/florida-nurse-convicted-fraudulent-orders-billing-medicare-200m