Miami Woman Pleads Guilty For Role in $1 Billion Fraud Case

Wednesday, January 23, 2019
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On January 23, 2019, a Miami woman pled guilty to conspiring to defraud the government and paying and receiving kickbacks as part of a $1 billion health care fraud scheme. The former Director of Outreach Programs at Larkin Community Hospital will face a prison sentence of up to five years on the single count. Federal prosecutors agreed to drop seven additional charges and seek a sentence at the low end of the guidelines, according to the plea agreement.

Largest Health Care Fraud Case.

Federal prosecutors charged the defendant, along with two others in July 2016, alleging that for at least a decade the Miami-area residents ran a complex scheme to defraud Medicare and Medicaid. At the time, it was the largest criminal health fraud case ever brought against individuals by the United States Department of Justice (DOJ).

According to prosecutors, the scheme involved kickbacks and exploitation of drug-addicted patients.  Although it’s not clear how much of the $1 billion in allegedly false billing was actually paid, the indictment says Medicare shelled out at least $464 million in improper reimbursements.

Defendant's Role.

Prosecutors alleged that more than $2.9 million in losses to Medicare and Medicaid could be attributed to the defendant alone, according to case documents. She stipulated that from January 2002 through late July 2016, she knowingly and willfully conspired with defendants on the scheme.
Additionally, the defendant admitted she exploited her position at the hospital to benefit the scheme, paid kickbacks to physicians to refer patients to the hospital, and also received kickbacks.

In an effort to conceal the kickbacks, she created or facilitated the creation of sham medical directorship contracts for the physicians, she admitted.

The defendant also faces an increase in her sentence due to the nearly $3 million in loss attributed to her offenses and to obstruction of justice.  Prosecutors said they would ask for a reduction in the guidelines based on her acceptance of responsibility.

U.S. District Judge Robert N. Scola Jr. may impose up to three years of supervised release and a fine of as much as the greater of $250,000 or twice her gain from her offenses, according to the plea deal.  Click here to go to our website and read the plea agreement in full.

Click here to read one of my prior blogs I wrote on this case.

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Hale, Nathan. “Ex-Hospital Director Pleads Guilty In $1B Health Fraud Case.” Law360. (January 23, 2019). Web.

Weaver, Jay. “Bribes to low-paid state worker key to $1 billion Miami Medicare fraud case, prosecutors say.” Miami Herald. (July 29, 2017). 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. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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