Federal authorities are very serious about healthcare-related fraud. As a result, the penalties in these cases can be very severe. Even defendants who participated only on the edges of a scheme can face hefty prison sentences.
A Miami-area businessman received one such sentence for his role in a large Medicare fraud scheme. Although he pled guilty to only one count of conspiracy to pay and receive kickbacks, the businessman will serve four years in a federal prison followed by three years of probation. The businessman will also have to contribute to a $2.5 million restitution fund with his co-conspirators.
According to prosecutors, the businessman played a role in a $205 million scheme to defraud Medicare. As the owner of a company that operated several halfway houses in Florida, the businessman apparently referred Medicare patients to another company. The other company billed Medicare for allegedly unnecessary treatments and paid some of that money back to this businessman. By receiving payments for referring Medicare patients, the businessman ran afoul of federal laws.
It is not clear whether the businessman knew it would be a crime to receive financial compensation in return for patient referrals or if he knew that the other company was submitting fraudulent bills. In any case, the businessman got caught up in the federal government's aggressive focus on healthcare fraud. Even though he never directly tried to defraud Medicare, this businessman will still serve a lengthy prison sentence. The damage to his business may also be permanent.
This case demonstrates the importance of consulting with an experienced healthcare fraud attorney to defend against a government investigation.
Source: Sun Sentinel, "Halfway house operator gets four years for Medicare fraud," Wayne K. Roustan, Oct. 18, 2012