Two Men Charged In Healthcare Fraud Scheme

Healthcare fraud criminal cases are becoming much more prevalent in the news over the past few years. Public insurance like Medicare and Medicaid is a prime target for fraud. Billions are lost each year when health care clinics overcharge a patient’s insurance for unnecessary procedures, services they never acquired, or backroom deals to funnel patients to specific providers. Each of these is illegal and the federal government takes fraud against public insurance very seriously.

In this case, the two men are accused of filing fraudulent claims for durable medical equipment. According to prosecutors, they bought and sold prescriptions and filed false claims based on those prescriptions. The entire scheme cost public insurance an estimated $11 million.

Such fraud schemes are blamed for driving up the cost of health insurance in the country.

Understanding the scheme 

The indictment alleges three forms of fraud. Firstly, the men are accused of purchasing fraudulent prescriptions from doctors who in fact, never signed these prescriptions and were unaware their names were being used to fill the prescriptions. Second, in some cases, the fraudulent prescriptions were then sold to medical device companies. Then men received kickbacks from the proceeds. Lastly, the men are accused of fabricating companies that functioned as fraudulent medical device suppliers that filed fraudulent claims on public insurance.

The duo has been charged with four separate counts. Two counts are conspiracy to commit health care fraud and conspiracy to commit wire fraud and the other two counts are charges related to conducting the scheme. The wire fraud charges carry a maximum sentence of 20 years while the health care fraud charges carry a maximum sentence of 10. The charges related to anti-kickback statutes have a maximum of 5 years in prison giving both defendants a total of 65 years in potential sentencing.

Why was the scheme doomed? 

The defendants were able to get away with the scheme for a while before they were caught, but therein lies the problem. Once an individual is convinced that the scheme is foolproof, they continue to commit the fraud in larger ways. Toward the end of their efforts, they were setting up fraudulent companies to file fraudulent claims on Medicare. They were using forged prescriptions by real doctors. A claims adjuster only has to follow up with one doctor who says they never had that patient, and they never wrote the prescription, and suddenly, all eyes are on the medical device companies that are benefiting from the prescriptions. So, while filing a couple of fake claims may never make it on anyone’s radar, actively using the infrastructure of the law to perpetrate an obvious fraud leaves a paper trail. So, on a long enough timescale, most who perpetrate these schemes fall into the trap of thinking they can get away with it forever and end up facing 65 years on federal charges.

Talk to a Tampa Federal Defense Attorney Today 

The Matassini Law Firm focuses on complex crimes involving violations of federal law criminal. This includes many white-collar crimes like the above-mentioned. Call our Tampa criminal lawyers today to set up an appointment and we can begin preparing your defense immediately.

Resource:

justice.gov/usao-sdny/pr/two-florida-men-charged-11-million-medicare-fraud-scheme-traffic-prescriptions-medical