Health Care Fraud Blog

WASHINGTON, D.C. (October 28) Today in Washington, D.C., the Attorney General’s Award for Distinguished Service was also awarded to employees from the Fraud Section of the Criminal Division of the Department of Justice, Deputy Chief Kirk Ogrosky; Trial Attorneys John S. Darden and Harold “Hank” B. Walther; and Senior Program Analyst Steven G. Shandy; from the U.S. Attorney’s Office for the Southern District of Florida, Assistant U.S. Attorney Randall D. Katz; former Assistant U.S. Attorney Matthew I. Menchel; and Nurse Investigator Edith M. Sposato; from the FBI Miami Division, Supervisory Special Agents Randall C. Culp and Timothy P. Donovan; Special Agents Susan E. Devereaux, Scott P. Neville, Shaun P. O’Neil and Brian Waterman; and from the Office of the Inspector General, Office of Investigations, Department of Health and Human Services, Assistant Special Agent in Charge Bernardo Rodriguez; Special Agents Manuel Hernandez, Julie Rivera and Ariel Rodriguez.

The team received the award for their tireless efforts to fight and deter Medicare fraud. During a seven-month period from March through October of 2007, the team indicted 74 cases and 120 defendants. Their efforts contributed to a drop in Medicare Part B billing of $1.4 billion when compared to the prior year. The tireless work, innovation and initiative of these award recipients to fight Medicare fraud exemplify the Department’s commitment to fraud prevention.

To read more, click here.

By Benson Weintraub, Esq.

FORT LAUDERDALE, FL (October 25, 2008) My interest in health care fraud originated as a white collar criminal defense lawyer in the federal courts with an abiding commitment to academic excellence, particularly in the criminal justice environment.

But when the proportion of health care fraud cases in which I participated increased so significantly, this did not occur in a vacuum. So, too, was the proliferation of this type of fraud increasing in prosecution at an incalculable rate.

As a scholar in sentencing law and policy, individual and corporate, I intuitively search for explanatory reasons for trends in criminality and reactive public policy on a federal, state, and local level.

An holistic approach to fluctuating crime rates, detection and prosecution, sentencing, imprisonment, all require the analyst to address the interplay of predominating political, economic, and social priorities established by governments at every level. Sometimes, this permits a remedial integration of resources to conserve capital outlay and expenditures. In other cases, however, the aggregation of social, economic, and legal policies which governments face must be driven by a maximization and continuity of provider-type services.

Continue reading "Healthcare in America: Guns or Butter?" »

By Benson Weintraub, Esq.

FORT LAUDERDALE, FL (October 19, 2008) Economic prognosticators theorized a maximization of wealth through a combination of largely unregulated commercial notes and instruments including sub-prime mortgages secured or subject to credit default swaps or government backed securities; irrespective, the taxpayers were ultimately left holding the billion dollar bag while the investment banks and financial institutions profited by a billion-dollar is the federal government’s subsidies and bailout.

The global financial exchanges each sustained similarly devastating losses created by the integral linkage between foreign banks, especially the of Chinese banks and American institutions which ripped through Freddy and Fannie, largely because of a variant of [unregulated] “insurance,” e.g., credit default swaps in which the notes or “policies” were transferred anonymously connecting other holders, these institutions spiral downward when the underlying note is due or ripe for foreclosure.

Continue reading "Collapse of Financial Markets and Its Impact Upon National Health Care Priorities " »

Eight Miami-Dade County residents have been charged in a 16-count indictment for their alleged roles in a Medicare fraud scheme involving fake HIV infusion treatments.

After the arrests, the Sept. 24, 2008, indictment was unsealed charging one count of health care fraud conspiracy against Juan A. Marrero, a/k/a Tony Marrero; Orlando Pascual Jr.; Belkis Marrero; Dr. David Rothman; Luz Borrego; Dr. Keith Russell; Eda Milanes; and Jorge L. Pacheco.

In addition to the conspiracy charge, Tony Marrero is charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Pascual is also charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Belkis Marrero is additionally charged with six counts of health care fraud, one count of money-laundering conspiracy and one count of money laundering. In addition to the conspiracy charge, Rothman and Borrego are each charged with four counts of health care fraud, and Milanes, Russell and Pacheco are each charged with two counts of health care fraud. The indictment also seeks forfeiture from all defendants.

According to the indictment, Tony Marrero, Pascual and Belkis Marrero controlled the day-to-day operations of two Miami medical clinics: Medcore Group LLC (Medcore) and M&P Group of South Florida Inc. (M&P). As medical assistants, Borrego (at Medcore), Pacheco (at M&P) and Milanes (at M&P) provided unneeded HIV infusion treatments to paid patients. The indictment charges that Pascual, Borrego and Milanes delivered cash payments to the patients. Furthermore, the indictment charges Rothman with ordering the unnecessary treatments at Medcore, and Russell with ordering the unnecessary treatments at M&P. Rothman and Russell allegedly conducted cursory examinations of the beneficiaries and signed the required documentation, including medical and billing records, to make it appear that the injection and infusion treatments billed by Medcore and M&P were medically necessary and provided, when, in fact, they were not.

Juan Marrero, Pascual, Belkis Marrero, Rothman and Borrego allegedly caused Medcore and M&P to submit fraudulent claims to Medicare for more than $5.3 million. The indictment alleges that the defendants laundered a portion of the proceeds to acquire the cash necessary to pay the patients.

In the event of conviction, the advisory sentencing guidelines sentence range will be determined by measuring the dollar amount of the loss suffered. It is anticipated that lawyers for the government will advocate that loss is equal to the intended loss - an amount equal to the dollar amount alleged in the indictment. However, we have been successful in persuading federal judges that an obscure provision of “Special Rules” in the calculation of loss under the Federal Sentencing Guidelines is instructive and resulted in a significant exclusion of “relevant conduct” claimed by the government and a Guideline range approximately half of that requested.

As reported earlier in this blog, (click here and here) one U.S. District Court Judge has declared that he didn’t care whether the government proved the “submitted” amount as “intended loss” when the law actually requires calculation of the “allowed amount” minus 20 percent.

Continue reading "MEDICARE FRAUD STRIKE FORCE INDICTS EIGHT MIAMI-DADE RESIDENTS FOR AIDS/HIV INFUSION FRAUD" »