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Local doctor sentenced to 20 years for medicare

Posted on June 28, 2011 12:00 AM EST

A federal judge sentenced a doctor to 20 years in prison for his involvement in a Medicare fraud scheme that cost the federal healthcare system millions of dollars. The defendant appeared with his Miami criminal attorney and attempted to avert a lengthy prison term by arguing that his client should not die in prison and that he suffers from a heart condition and diabetes. The federal court judge presiding over the sentencing hearing felt little sympathy for the defendant. On the record, the judge chastised him for violating his medical oath, billing the Medicare system and disgracing himself, his family and the community. The defendant was found guilty of charges involving his receipt in excess of a million dollars for writing fake prescriptions with the intent to defraud Medicare. The jury found that the doctor was involved in billing Medicare for HIV treatments that were unnecessary or never provided to patients.

The sentence handed down was the second harshest ever involving a medical doctor convicted of being involved in healthcare fraud. A Miami-Dade physician was charged with a similar Medicare fraud in 2008 and was sentenced to 30 years in prison. That sentence was upheld last year in appellate court with a former United States Supreme Court Justice sitting as a guest judge. She declared, "a doctor should be treated more severely than other participants because the doctor is breaching a position of trust and an ethical obligation to put the patient's interests first." The judge hearing the case yesterday repeated the same sentiments. The defendant helped operate the scheme using two clinics to bill Medicare. The owner of one of the clinics suffered a far less fate as she cooperated with the government to prosecute other perpetrators.

In federal court, defendants that cooperate with government receive significantly reduced prison sentences than those who go to trial and are convicted by a jury. While cooperating with the government against people you know and used to work with is definitely a difficult situation, it is far better than receiving a double digit prison sentence. Every defendant in federal court should seek qualified representation before deciding to accept or reject a plea. While this decision is always difficult, the case and the evidence supporting it must be critically analyzed to support this decision. The benefit of accepting a plea results in significant level reductions under the sentencing guidelines and of course the benefit of a large sentence reduction that comes with a 5K supported by federal prosecutors.

Federal prosecutors continue to focus on Medicare fraud cases involving HIV treatments, as clinics, mostly in the Miami-Dade area, have billed in excess of $2.2 billion worth of infusion bills. Clinics in the South Florida are have billed for 72% of all HIV Medicare claims despite the fact that only 8% of the population with HIV reside in the same area. While the defense lawyer representing the doctor attempted to appeal to the softer side of the judge, government prosecutors convinced her that the defendant deserved no sympathy and should be sentenced to 30 years in prison. Both the government and the judge focused on the fact that the defendant was a doctor and should be sentenced accordingly for this breach of trust.

Medicare Fraud Nets 20-Year Prison Sentence for Miami Physician, Miami Herald.com, June 27, 2011.
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