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Miami Man Gets 14 Year Sentence In Medicare Fraud Case

The former owner of a string of discount pharmacies was sentenced to 14 years in prison this week. The man pleaded guilty last December to charges of conspiracy to commit health care fraud and conspiracy to defraud the United States. According to the allegations against him, he defrauded the government of $23 million in fraudulent Medicare claims. In addition to the lengthy prison sentence, the man will likely be ordered to pay restitution. The issue of restitution will be decided in a hearing scheduled for late April.

The Miami man, Jose Carlos Morales, used information obtained from area assisted living facilities to file false claims for Medicare reimbursement. He paid people in the facilities kickbacks for providing him with the information he needed to file the false claims. He also participated in a scheme to pay illegal kickbacks to doctors so they would supply him with prescription referrals. Finally, Morales was accused of improperly providing the assisted living facilities with medications and of repackaging unused and partially used medications and selling them to the public.

The owner of the Pharmovisa discount pharmacies will likely be ordered to pay millions of dollars in restitution. Medicare fraud has been the subject of increasing attention from state and federal investigators. Doctors, pharmacists, executives and medical companies and others have found themselves under increasing pressure regarding the proper filing of Medicare claims. It is unclear if the criminal prosecutions and orders of restitution have impacted the financial health of the Medicare program.

Source: South Florida Business Journal, "Pharmovisa owner gets 14 years in $23M Medicare fraud," by Paul Brinkmann, 25 February 2013

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