Wednesday, March 2, 2005

Health Care Fraud Indictment + Money Laundering

The government is proceeding with another health care fraud case.  This time it is the USA in Florida announcing the filing of charges. And as with so many white collar charges being brought recently, the latest prosecution tacks on charges of money laundering.

Using 18 U.S.C. section 1347, a relatively new health care fraud statute, USA Marcos Daniel Jimenez announced an indictment charging "conspiracy to commit health care fraud and to pay kickbacks," 19 counts of health care fraud, a conspiracy to commit money laundering and 11 counts of money laundering. The indictment also has a forfeiture claim, in the amount of more than 10 million dollars.

According to a press release issued by the USA of the Southern District of Florida, five individuals are accused in this case.  The press release states in part that some are accused of paying:

"kickbacks to patient recruiters so that they would provide the defendants and their companies with Medicare beneficiaries to pose as patients, and to patients in order to obtain from those Medicare beneficiaries their names and identification numbers, along with prescriptions for Durable Medical Equipment (DME) and prescription drugs relating to them.

"Once they had patient information, the defendants completed Medicare required orthotic measurement forms for DME without an orthotist or orthotic fitter ever having measured a patient, forged the signatures of doctors on prescriptions for DME and prescription drugs, and created entirely fraudulent patient files, containing manufactured and forged documents. The defendants would share patients between the defendants’ two (2) companies, billing the shared patients during different Medicare billing periods, without the patients having been seen by any doctor, orthotist, or fitter, and without having been prescribed any DME or prescription drugs. Using the patients’ identification information and prescriptions, the defendants then submitted claims to Medicare for reimbursement for the cost of DME and prescription drugs, and received payments from Medicare.

"The defendants, as alleged, then laundered some of the proceeds of the fraud by paying someone who they believed was a newspaper owner for bogus advertising that was never placed. The defendants would pay for the nonexistent advertising using a check from either or both of the DME companies and the newspaper owner would pay them back in laundered U.S. currency."


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