How Could Someone Be Charged With Healthcare Fraud In South Florida?

Several weeks ago, two South Florida brothers were convicted of conspiracy to commit healthcare fraud, eight counts of healthcare fraud, and wire fraud, in addition to two counts of paying and receiving kickbacks. The brothers orchestrated an elaborate scheme where they would submit false bills to Medicare and private insurers for patients who were supposedly undergoing detoxification from illegal drugs and alcohol. The brothers billed for patient therapy sessions that never occurred and supplied patients with “detox drinks” that were chock full of controlled substances, unbeknownst to them.

Recruiters for the fraudulent detox facility would “recruit” patients by supplying them with illegal drugs, convincing them to enroll in the outpatient rehabilitation program. Meanwhile, the brothers falsely applied for PPP loans after the COVID-19 pandemic and billed more than 112 million in false claims to private insurers and the Center for Medicaid Services (CMS). Patients and recruiters also received kickbacks for referrals and the brothers paid kickbacks to testing facilities. Both defendants could face years in prison depending on the outcome of sentencing. What is healthcare fraud, and what are the penalties?

What is Healthcare Fraud?

Healthcare fraud is a federal crime. It can be committed by patients, treating providers and other medical professionals. Anyone who obtains medical treatment under false pretenses or intentionally deceives the healthcare system by submitting bills for reimbursement for services that were not rendered or were not medically necessary can be charged with medical fraud.

Doctors, therapists and outpatient facilities might engage in healthcare fraud by offering services to patients who do not need it, recruiting patients through unsavory means (i.e. kickbacks) or telling patients they are suffering from an illness or injury in order to fraudulently bill for more expensive services. Doctors might double bill for the same service, bill for a patient who does not exist or submit multiple bills for the same service to be paid twice by the insurer.

When not identified, this raises the cost of premiums and healthcare services for all insured consumers and contributes to medical waste. It also erodes the public’s faith in the medical profession. A defendant can face civil and criminal penalties for violating the False Claims Act. Civil penalties range from $5,000 to $10,000. Criminal penalties may include five years in prison for each count plus additional penalties up to $25,000. In the next installment of this blog, we will discuss what kickbacks are and what the penalty for receiving or paying kickbacks is.

Contact West Palm Beach White Collar Attorney William Wallshein

Being accused of a white-collar crime is extremely serious. These crimes carry hefty penalties and prison time and are often prosecuted in federal court, meaning if convicted, the defendant is ineligible for parole. If you have received a target letter in the mail or are the subject of a federal criminal investigation, it is crucial that you speak to an experienced West Palm Beach white collar crimes attorney as soon as possible. Attorney William Wallshein has more than 38 years of experience handling every type of criminal charge and advocating for his clients, no matter how dire the circumstances. Call him today to schedule a free consultation.

Sources:

oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/

nbcmiami.com/news/local/south-florida-brothers-who-ran-detox-facilities-convicted-in-112m-fraud-scheme/2608352/