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Former trafficker charged with medicare fraud

Posted on July 27, 2011 12:00 AM EST

A South Florida man previously convicted of cocaine trafficking and money laundering has been charged with committing Medicare fraud. The indictment alleges that Luis Alejandro Sanz, who had previously served a five year prison sentence, opened a healthcare clinic to purportedly treat diabetes patients. Court documents allege that he billed the federal healthcare provider $11 million of which he actually received $7 million. Because of his past criminal record, Sanz enrolled his wife as the sole proprietor of the clinic to avoid detection. Both defendants are scheduled to appear in court with their Miami criminal attorneys this week for their arraignment.

Earlier in the week Sanz and his wife were indicted on charges of healthcare fraud, money laundering and for paying kickbacks. The clinic operated from 2006 to 2009 obtaining clients through the use of patient recruiters. This is not the first instance where previously convicted felons have turned to healthcare fraud. Despite the law that precludes individuals with prior felony convictions from being Medicare providers, several have slipped through the cracks. While it is almost impossible for the federal healthcare agency to detect who put the money up to start and run the clinic, the Medicare program has dumped millions of dollars into its security system in an effort to prevent millions of dollars of fraud from occurring.

Congress awarded Medicare $350 million in the Affordable Care Act to develop software which allows for stricter screening of Medicare claims. Previously, Medicare used the "pay and chase" method for combating fraud. While many prosecutions and convictions resulted from this approach, the federal government could not recoup the money after the scams had already been completed. The new software being used by the healthcare program along with stricter screening for healthcare providers is intended to prevent the fraud and save the taxpayers millions of dollars. Time will tell if the new initiative will be more effective in combating fraud than its predecessor.
The upgrades in fraud prevention come as a result of millions of dollars in losses to the federal government. It is well documented that the majority of fraud was committed in Miami and throughout the South Florida area. Along with the fraud detection upgrades, the Medicare fraud task forces across the country are working in concert and sharing information.

While Medicare fraud itself is not a serious offense as far as punishment is concerned under the federal sentencing guidelines, the risk lies in the multi-level increases that are directly correlated to the amount of the loss suffered by Medicare. In South Florida, Defendants charged with Medicare fraud are facing 24 to 48 months if they enter guilty pleas and cooperate with government prosecutors and investigators. Defendant who go to trial and are convicted by a jury are looking anywhere from 10 to 20 years depending on their involvement in the fraud. At the present time, individuals charged with Medicare fraud are in the cross hairs of the United States Attorney's Office. Any charged with or being investigated for healthcare fraud, should retain a criminal lawyer with experience in defending these types of cases in federal court.

Former Miami Drug Trafficker Now an Accused Medicare Scammer, Miami Herald.com, July 27, 2011.
Categories: Fraud