January 18, 2018
In November, a Florida doctor was sentenced to a four-year prison term for health care fraud and money laundering. This case is a reminder that the federal government continues to pursue health care fraud aggressively and isn’t afraid to use its full resources to go after suspected scammers. Accused defendants will need a skilled health care fraud defense attorney fighting in their corner if they hope to avoid prison.
The Facts
Joaquin Mendez, 52, pleaded guilty to conspiracy to commit health care fraud for his work for Reflections Treatment Center, a sober home in Broward and Palm Beach owned by Kenneth Chatman. As part of the fraud, Mendez approved testing that was unnecessary for patients he had never examined in person. He also signed off on hundreds of saliva and urine tests after patients had already had the tests or had already been discharged.
As prosecutors argued, Mendez was well aware of the fraud Chatman was committing and was, therefore, a willing participant in the scheme. After pleading guilty, Mendez was sentenced to four years in prison and ordered to pay over two million in restitution to his victims.
Health Care Fraud Schemes
Health care is a huge industry in the United States right now, so opportunities for fraud are plentiful. Some of the more common fraudulent schemes involve the following:
- Billing for services that were never provided
- Providing a non-covered service but billing for a covered one
- Falsely claiming office visits to get reimbursed
- Overusing services
- Unnecessarily issuing prescription drugs
- Receiving kickbacks or bribes, often to make referrals that aren’t necessary
By far, billing for services that weren’t provided is one of the easiest frauds to commit. The healthcare provider submits forms to either the government or private health care plans and claims to have provided services that were never rendered. By getting reimbursed, the doctor essentially steals from the insurer.
Punishment for Medicare Fraud
Medicare is the largest insurer in the U.S., handling over a billion claims a year. For this reason, a lot of fraud is committed against the government, which can result in serious penalties for convicted defendants. Defendants are typically looking at fines, jail time, and providing restitution to victims.
Several different laws prohibit Medicare fraud, and each carries its own punishments. For example, the Health Care Fraud Statute makes it illegal to knowingly and willfully defraud a health care program. For violating this law, you can be imprisoned for up to 10 years and be fined up to $250,000. Other laws allow the government to force you to pay restitution three times the amount you defrauded. Generally, the more money you defraud, the greater the punishment.
Call a St. Petersburg Criminal Defense Attorney Today
As the case against Mendez shows, rooting out medical fraud will be a concern for the current Presidential administration as it was for the previous ones. Khonsari Law Group is experienced providing top-shelf white collar criminal defense to people accused of medical fraud. Call us today at (727) 269-5300 or complete an online contact form. Consultations are free.