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100 South Floridians Charged in Largest National Health Care Fraud Takedown in History

On June 22, 2016, the U.S. Attorney’s Office for the Southern District of Florida announced that “100 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare and Medicaid out of approximately $220 million.”  This mass takedown – the largest in the history of the Medicare Fraud Strike Force – was part of a nationwide operation that resulted in charges against 301 individuals, including 61 doctors, nurses, and other licensed professionals.

Source:   https://www.justice.gov/usao-sdfl/pr/100-charged-southern-district-florida-part-largest-national-health-care-fraud-takedown

Ten-year Sentence for South Florida Home Health Agency Administrator Convicted in $2.5 Million Medicare Fraud Scheme

On February 24, 2017, the administrator of a South Florida home health agency was sentenced to 126 months’ imprisonment for participating in a $2.5 million Medicare fraud scheme – specifically, for submitting false claims to Medicare for services that were not medically necessary, not actually provided, and for patients that were lured through the payment of illegal kickbacks to doctors and patient recruiters.

Source:    https://www.justice.gov/usao-sdfl/pr/administrator-miami-area-home-health-agency-sentenced-126-months-prison-involvement-25

A. Healthcare Fraud

The Federal healthcare fraud statute (18 USC § 1347) makes it a crime to knowingly and willfully execute, or attempt to execute, a scheme or artifice to defraud a health-care benefit program, or to get any of the money or property owned by, or under the custody or control of, a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises.

Healthcare fraud is normally charged against pharmacies and healthcare providers (and also against individual managers, owners or healthcare professionals associated with such entities) that submit claims to Medicare or Medicaid for treatments that were medically unnecessary or never provided.

Healthcare fraud is a serious crime, and a conviction can result in a sentence of up to ten years’ imprisonment.

B. Healthcare Kickbacks

Under the Federal anti-kickback statute (42 USC § 1320a-7b), it is a crime to solicit or receive kickbacks in connection with Federal healthcare program payments.

Patient recruiters and Medicare/Medicaid beneficiaries are often paid cash kickbacks in return for acquiring beneficiary information for healthcare providers, who then submit fraudulent bills to Medicare/Medicaid for services that are either medically unnecessary or never performed.

A conviction under the anti-kickback statute can result in a prison sentence of up to five years.

C. If You Have Been Charged with a Federal Healthcare Crime

If you or your company has been charged with healthcare fraud or with soliciting or receiving healthcare kickbacks, first these charges have probably been filed in a federal court.  Second, just being charged with a Federal healthcare crime can result in you or your company being suspended from Medicare / Medicaid.  Therefore, in the event you have been accused of a federal crime such as healthcare fraud, it is critical that you seek the advice and counsel of a lawyer that is experienced in federal criminal law and in federal criminal court.  While many lawyers practice in the field of criminal defense, very few are experienced in defending federal criminal charges in federal criminal court.  Deric Zacca is an experienced federal criminal defense lawyer who has handled over 100 federal criminal cases.  Call him today for an initial consultation.