Health Care Fraud
A second person arrested in a wide-ranging federal investigation into insurance fraud by South Florida sober homes has pleaded guilty to health care fraud conspiracy.
The Sun-Sentinel reports the 45-year-old defendant conceded before the court that he had accepted nearly $250,000 in kickbacks to refer clients living in his sober living homes for testing and treatment for substance abuse. Additionally, he reportedly sent some 60 clients with health insurance to two different recovery centers, and those centers in return sent him approximately $500 a week.
At this point, authorities have arrested seven people for health care fraud conspiracy at sober homes throughout Broward and Palm Beach counties. A 46-year-old man from Boynton Beach was the alleged ringleader of the operation. Meanwhile, this defendant who recently pleaded guilty faces up to 10 years in federal prison.
These kinds of cases are becoming increasingly common in Florida, which has been identified by federal authorities as a problem area for health care fraud. The New York Times reported last year that the biggest health care fraud cause the U.S. Justice Department has ever brought arose from an elaborate alleged scheme in South Florida by the owner of a network of nursing home facilities. That case involved an alleged more the owner had defrauded Medicare and Medicaid of an estimated $1 billion over the course of 14 years.
Most of these cases result in federal charges, such as those that fall under:
- The Health Care Fraud Statute
- The False Claims Act
- The Anti-Kickback Statute
- The Patient Access and Medicare Protection Act
- Exclusion Provisions
- Civil Monetary Penalties Law
However, a lot of states have similar laws too, including Florida. F.S. 817.234 is Florida’s false and fraudulent insurance claims statute. That law lays out all the different circumstances under which one might commit fraud against an insurer. Prosecutors have to prove the individual’s actions were carried out with the intention to injure, defraud or deceive.
Individuals who are facing these charges need to consult with an experienced criminal defense lawyer because the penalties can be severe.
Penalties for violating this statute depend largely on how much money was involved. For example, if the value of the property was less than $20,000, offender commits a third-degree felony, punishable by up to five years in prison. However, if the property/ monetary value was greater than $20,000 but less than $100,000, offender commits a second-degree felony, punishable by up to 15 years in prison. If the property/ monetary value was more than $100,000, offender commits a felony of the first-degree, which is punishable by up to 30 years in prison. All of these too have varying fines and civil penalties also.
Health care service providers – such as those at the sober homes – are responsible for knowing federal laws and the state statutes where they practice. Those that engage in fraud, waste and abuse can be targeted for these kinds of action, as these recent cases show. Federal and state prosecutors have been increasingly targeting these kinds of activities.
It may be possible for a defendant to negotiate a lesser charge or even to have a case dismissed altogether. However, this will not happen without assistance from a skilled white collar defense attorney.Insurance fraud