Medicare Fraud Scheme Results in a Five-Year Prison Term for Owner of Orlando Health Care Clinic

Thursday, October 8, 2015
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An Orlando health care clinic owner who engaged in a $2.4 million scheme to defraud Medicare will spend the next five years behind bars.  Juan Carlos Delgado and his wife, Nereyda Infante, co-owners of the clinic, were charged with conspiracy to commit health care fraud.  The pair pleaded guilty on June 24, 2015, before United States District Judge Paul G. Byron of the Middle District of Florida.  Delgado will serve a five year prison term while Infante has been sentenced to one year and one day in prison.  Additionally, the court ordered the defendants to pay restitution in the amount of $1,520,850.  


The Alleged Medicare Fraud Scheme.


Delgado and Infante owned and operated several health care clinics throughout Orlando, Florida.  Each clinic was doing business under some variation of the name Prestige Medical.  In connection with their guilty pleas, Delgado and Infante admitted to fraudulently billing Medicare over a period of approximately two and a half years, for services never rendered or medications that were not prescribed.  

One of the medications they admitted to routinely billing for was pentostatin, a costly drug used to treat leukemia.  Delgado and Infante admitted to never administering this medication to their patients even though $1.2 million of the overall $2.4 million billed to Medicare was billed specifically for pentostatin.  

Delgado and Infante also admitted to submitting false documents to Medicare regarding the ownership and operation of Prestige clinics throughout Orlando, Florida in furtherance of their scheme.  

To read the full press release from the Department of Justice, click here


Billing Practices to Avoid.

The government places an exorbitant amount of trust in health care professionals to provide necessary, cost-effective, and quality care to patients.  Payment of claims is based almost solely on what is included in the claim by the signatory physician.  The powerful and extreme criminal and civil laws enacted by Congress in response to fraudulent activity is a direct result of the amount of trust invested in physicians by the government.  Understandably, breaking that trust results in severe penalties.  

Accordingly, here are some billing practices every physician or other health care provider should strive to avoid:

(1)    "...billing for services that you did not actually render;

(2)    billing for services that were not medically necessary;

(3)    billing for services that were performed by an improperly supervised or          unqualified employee;

(4)    billing for services that were performed by an employee who has been excluded
         from participation in the Federal health care programs;

(5)    billing for services of such low quality that they are virtually worthless; and

(6)    billing separately for services already included in a global fee, like billing for an
         evaluation and management service the day after surgery."

Click here for more information directed at physicians regarding how to best avoid fraud and abuse in government health care programs. 

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses.  In many cases, those subject to Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter.  Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare audits. 

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.  

If you are accused of Medicare fraud, realize that you are in a fight for your life.  Your liberty, property/possessions and profession are all at stake.  Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines.  If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison.  Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.


Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.


The attorneys of The Health Law Firm represent healthcare 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 or (850) 439-1001.


Sources:

Department of Justice, Office of Public Affairs.  "Owner of Orlando Health Care Clinic Sentenced to Five Years in Prison for Engaging in Medicare Fraud Scheme."  Press Release: 29 Sept. 2015.  Web.  7 Oct. 2015.

U.S. Department of Health and Human Services, Office of Inspector General.  "A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse."  OIG Web Site:  http://oig.hhs.gov/fraud/PhysicianEducation/.  7 Oct. 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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10/8/2015

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