By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On Friday, a Florida federal jury convicted the president of a Miami-based transportation company of helping coordinate the payment of illegal kickbacks in a $70 million health care fraud scheme. The scheme involved three Miami mental health facilities.
Conspiracy to Pay Health Care Kickbacks.
According to the U.S. Department of Justice (DOJ), Damian Mayol, president of Transportation Services Providers Inc., was convicted of one count of conspiracy to pay health care kickbacks. Mayol used the company to coordinate the illegal kickbacks to recruiters, who then referred patients to three clinics: R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC.
According to prosecutors, the three mental health clinics billed Medicare for partial hospitalization program services that were not medically necessary or were not provided. Between January 2008 and December 2010, $70 million in false claims were submitted to Medicare.
Medicare Fraud Strike Force’s Nationwide Takedown.
The scheme was uncovered by the Medicare Fraud Strike force, during a nationwide takedown in June. Three others that were involved in the scheme already pled guilty in October. Santiago Borges, Erik Alonso and Cristina Alonso pled guilty to similar and related charges for their involvement in the scheme.
To read the DOJ’s press release on this case, click here.
Psychologists and Other Mental Health Professionals Are Not Immune to Fraud Investigation and Audits.
Facing allegations of Medicare and Medicaid fraud or other types of health care fraud is extremely serious. If you lose, it is highly likely you will spend many years in prison. You will lose your medical license. You will be excluded from Medicare and Medicaid, as well as any other government health care programs.
Be aware that when the Florida Medicaid Fraud Control Unit (MFCU) gets involved, the situation has escalated from routine to serious. The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.
Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
“Miami Man Convicted In $70M Medicare Fraud Scheme.” Law360. (January 15, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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