A doctor licensed in Puerto Rico practicing medicine in Miami was recently arrested on 16 federal charges related to an alleged $20 million health care fraud scheme that reportedly involved claims to Medicaid and Medicare that were either fraudulent or false. Federal authorities also say the doctor was illegally distributing oxycodone and a number of other powerful controlled substances.
Federal prosecutors with the U.S. Justice Department allege the 51-year-old defendant attempted to defraud the government and receive health care bribes and kickbacks. Specifically, he owned an operated several clinics in Miami that “purported to practice medicine as an area of critical need.” According to the indictment, defendant from 2009 through this year referred Medicaid and Medicare recipients allegedly under his care to a local discount pharmacy as well as several home health agencies. In exchange, prosecutors allege, defendant received kickbacks and illegal bribes from these entities.
Further, authorities allege the doctor submitted claims to Medicare Part D for services like office visits and procedures that he either didn’t provide or that clearly weren’t medically necessary. Some of those included billing for removing lesions and therapeutic injections he never actually gave, authorities said. Prosecutors assert that in some cases, he wrote prescriptions to powerful drugs known to be cause addiction (i.e., oxycodone, hydrocodone, alprazolam and others) even though there was no valid medical reason to do so.
All told, authorities allege this doctor and others who conspired with him stole some $4.5 million from the federal government just based on false claims and the doctor stole an additional $20 million from Medicare Part D.
It must be noted that at this juncture, these are merely allegations. Any person who is indicted is presumed to be innocent unless proven otherwise.
That said, our criminal defense attorneys in Miami recognize the severity of these charges, and the kind of resources and experience a law firm must have to properly combat them.
With regard to health care fraud, 18 U.S. Code 1347 holds that anyone who knowingly or willfully executes or attempts to execute a scheme or plan to defraud any health care benefit program or obtain payment for health services under false pretenses will face up to 10 years in prison. Bear in mind: This is for a single offense. In a case like this, federal prosecutors can charge multiple offenses.
Meanwhile, wire fraud as defined in 18 U.S.C. 1343 is identical to the federal mail fraud statute, except that the fraud scheme uses telephone calls or electronic communication in furtherance of the scheme as opposed to the mail. The four essential elements are:
- Defendant voluntarily or intentionally planned or participated in a scheme to defraud another out of money;
- Defendant did so with intent to defraud;
- It was reasonably foreseeable that interstate wire communications would be used;
- Interstate wire communications were used.
We are likely to see many more of these cases, given that the federal government has prioritized it with its Medicare Fraud Strike Force, which was launched in 2007 and since then operates in nine cities (including Miami) and has in that 10-year window prosecuted some 3,000 defendants.
Contact the Miami criminal defense lawyers at Jacobs Keeley at (305) 358-7991 for a free consultation on your pending criminal matter.
Miami-Based Physician Charged for Role in Pain Pill Diversion and Medicare Fraud Scheme, March 23, 2017, Press Release, U.S. Department of Justice
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