Frank A. Rubino, ESQ.

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Guilt plea entered in Medicare fraud case

In a stunning Medicare fraud case, a man has pleaded guilty to intentionally defrauding Medicare and pocketing $13 million in illicit gains.

The guilty plea was entered last Friday in federal court. The man, 57, faces sentencing for being a part of the scheme in the case, which resulted in the millions of dollars being funneled into a Brooklyn-based medical clinic.

Court documents clearly illustrate how the scam unfolded. They detail how the man recruited beneficiaries of Medicaid and Medicare from 2009 to 2012. He would ply them with illegal kickbacks in cash, with the payoff being that they would then go to the Cropsey Medical Clinic.

There, they would get unneeded medical attention, including both testing and treatment. Medicaid and Medicare would then be billed fraudulently for that medical attention. The man running the scheme, along with his accomplices, would pocket the cash.

Armed with that money, he would repeat the scheme over and over, giving new patients cask kickbacks to visit that particular center. Like their predecessors, they too would get unnecessary medical care, with the clinic fraudulently billing Medicare. Additionally, the man and his co-conspirators at the clinic billed Medicare for ambulance trips, which were also unneeded. After all, patients were simply traveling from their homes to the clinic on non-emergency basis.

Overall, the man's scheme cost $5.7 to Medicaid and $8.1 to Medicare, resulting in the total of $13.8 million for the case. He is facing a sentence of up to five years, plus $429,000 restitution payments, $429,000 forfeiture costs, and an $850,000 fine.

In addition to the man who orchestrated the fraudulent scheme, patient recruiters, the clinic's manager, and the clinic's medical director were also charged.

Medicare fraud legal cases affect everyone in the country, since there is a limited amount of funds available to help patients. This certainly includes Florida, where the program is used to help a large number of people.


Source: 
Village Voice, "A Brooklyn Man Pleads Guilty to Involvement in $13 Million Medicare Fraud Scheme" Raillan Brooks, Sep. 09, 2013

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