A 70-year-old Miami man was convicted of illegally steering state-court defendants to a corrupt clinic, which in turned fraudulently billed Medicare for more than $63 million.
He was sentenced to five years in prison, plus three years of supervised release. And he must pay back a staggering $9.9 million in restitution.
He was found guilty of getting illegal payments from a corrupt clinic called in Miami, which fraudulently billed the Medicare system for more than $63 million.
The man got a flat monthly rate based on the number of patients he referred to the clinic.
In all, the clinic apparently paid him$432,829 over six years, aside from his regular salary as a mental health care worker.
The clients referred to the clinic cost taxpayers between $9.5 million and $25 million in bogus claims between 2006 and 2012.
The man was arrested in June 2017. He pleaded guilty to one count of conspiracy to defraud the United States and receive healthcare kickbacks.
The federal government has numerous laws in their back pocket in which they can pursue legal actions against those they believe are committing Medicare or healthcare fraud, including the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law, the Exclusion Statute, and the Civil Monetary Penalties Law.
Common claims brought under Medicare fraud include:
- Overbilling for services provided
- Unbundling services for higher payouts
- Upcoding for a higher level of service than that which was actually performed
- Billing for patients who do not exist
- Submitting bills for services that were not actually performed
The consequences of a government prosecution against you for Medicare fraud could include the following:
- Hefty fines
- Exclusion from all government health care payment programs
- Further disciplinary actions by other administrative agencies
- Loss of your professional license
- Criminal charges and jail time