Health care is one of the fastest growing business sectors in South Florida and across the United States. With such tremendous growth, however, comes the possibility of wrongdoing. In recent months, several individuals have been arrested, charged or sentenced on fraud claims involving health care operations. Typically, these cases involve fraudulent insurance claims.
In a recent case, the co-owner of Miami medical and rehabilitation clinics admitted to submitting more than $10 million in fraudulent health care claims. The scheme netted millions of dollars in ill-gotten insurance payments for the clinic owner and his co-conspirators. As a result, the clinic owner received a sentence of 97 months in federal prison, along with a three-year period of supervised release to follow his sentence.
The scheme involved the defendant's medical and rehabilitation clinics, which submitted nearly $7 million in fraudulent insurance claims to Blue Cross Blue Shield. The defendant then used some of these proceeds to purchase a fraudulent home health clinic. Through this clinic, the defendant and his co-conspirators submitted another $3 million in fraudulent claims to Medicare for services and benefits that were not medically necessary.
The Federal District Court Judge also ordered the clinic owner to pay over $4 million in restitution. In order to recover the restitution owed by the clinic owner, the U.S. Attorney will attempt to locate the clinic owner's assets, such as five homes that have already been seized. In such cases, the Court may appoint a receiver - usually an attorney or firm with extensive experience in these types of matters - to liquidate and distribute assets to victims of the fraud scheme.
Source: Justice.gov, "Miami Man Sentenced To More Than Eight Years in Prison for Role in $10 Million Health Care Fraud Scheme," Apr. 20, 2018