24-Year-Old May Spend Nearly a Decade Behind Bars as the Alleged Mastermind in a $21 Million Medicare Fraud Scheme

Tuesday, December 15, 2015
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On Thursday, December 10, 2015, 24-year-old, Daniel Suarez, was sentenced to nine years in prison and ordered to pay nearly $21 million in restitution by U.S. District Judge Donald Middlebrooks, for his alleged leading role in a Medicare fraud scheme in Miami, Florida.  Suarez was sentenced after pleading guilty in September 2015, as to one count of conspiracy to commit wire fraud and health care fraud.  

The indictment issued against Suarez and several family members named as co-conspirators, including Suarez's mother, was announced by the U.S. Department of Justice (DOJ) on Thursday, June 18, 2015, as a part of a larger South Florida sting conducted by the Medicare Fraud Strike Force.  The operation that brought down Suarez and select relatives, in addition to numerous other health professionals in South Florida alleged of Medicare fraud (totaling 73 individuals charged overall), was said by the DOJ to be the "largest national Medicare fraud takedown in history."

To read the full press release issued by the DOJ, click here


It's a Family Affair: The Alleged Fraudulent Scheme.


It was alleged that Suarez gained control of eight Florida pharmacies owned by alleged co-conspirator relatives in order to carry out a scheme to submit more than $20 million in false claims for prescriptions to Medicare and its private insurance plan sponsors.  It was reported by prosecutors that between September 2010 and February 2015, Suarez acted as the leader of the scheme, utilizing patient recruiters (along with his co-conspirators) to seek out and pay Medicare beneficiaries in exchange for their Medicare beneficiary numbers.  These fraudulently obtained numbers then served as the basis of claims filed with the Medicare Part D program for alleged false prescriptions.  Such prescriptions were reportedly either medically unnecessary or in certain instances, never prescribed by a physician at all.  

The indictment alleged that the pharmacies (all owned by the co-conspirators) worked collaboratively to obtain fraudulent prescriptions, further forge and alter prescriptions, and sell prescriptions to one another for the sole purpose of submitting false and fraudulent claims to the Medicare Part D program.  

Reportedly, there is debate as to whether or not Suarez is the real mastermind behind the operation.  It is contended that Suarez moved in with an aunt upon his arrival to the country, and she was allegedly already involved in Medicare fraud.  In any case, Suarez admittedly took the bait which will now see him spending much of his young life behind bars.  

To read the full indictment, click here


Medicare Fraud Is a Big Deal.


While nine years in prison may seem quite severe for 24-year-old, Suarez, he actually got lucky!  It was reported that the prosecution sought a 15-year prison term noting that such crimes are becoming increasingly common.  The government and law enforcement are in agreement that heightened deterrence for health care fraud is necessary and warranted.  

The government is serious about combating health care fraud.  It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs.  False claims are a growing problem in the program, costing the government billions of dollars each year.  Accordingly, punishments for defrauding the system can be quite severe.

U.S. Attorney Wilfredo A. Ferrer stated, "The Medicare fraud schemes continue to be relentless...Those who commit Medicare fraud through the filing of false claims, payment or receipt of kickbacks, or fraudulent medical practices will be held accountable for defrauding the U.S. government."  Special Agent in Charge Shimon R. Richmond, of U.S. Department of Health and Human Services Office of Inspector General's Miami regional office concurred, stating, "...our agents work hard and well to ensure those who steal from federal health care programs pay dearly for their crimes."  

For more information regarding Medicare audits, read my previous blog post here


Comments?


Are you currently involved in a Medicare audit or investigation?


Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.


The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.  They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620.


Sources:


Indictment.  6:4-5, June 4, 2015.

Novak Jones, Diana.  "24-Year-Old Gets 9 Years for $21M Medicare Fraud Scheme."  Law360.  Portfolio Media Inc.: 10 Dec. 2015.  Web.  14 Dec. 2015.

U.S. Attorney's Office, Southern District of Florida.  "Seventy-Three Charged in Southern District of Florida as Part of Largest National Medicare Fraud Takedown in History."  Press Release.  U.S. Department of Justice: 18 June 2015.  Web.  14 Dec. 2015.


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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12/15/2015

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