South Florida Criminal Defense Lawyer Addresses Medicare Fraud

May 19, 2009 by David S. Seltzer

The Miami Herald reported May 15 that three Miami-Dade men have been arrested for allegedly bilking Medicare out of $22.7 million. Two of them, Michel De Jesus Huarte and Ramon Fonseca, ran medical clinics in five states, including Florida, which they are accused of using to defraud Medicare. Another defendant, Vicente Gonzalez, is accused with the first two of conspiracy and money laundering. A fourth suspect is still at large. All of them face fines, repayment and up to five years in prison for each count of fraud.

According to the article, the clinic operators are accused of billing Medicare for expensive HIV and cancer-treatment procedures they did not perform. In fact, an FBI investigation found that several “patients” knew nothing about the clinics they were supposed to have visited for the procedures. Another died before the procedure was allegedly performed, and two of the clinics involved did not seem to exist except as post office boxes. Once they received Medicare reimbursements, the Herald said, the conspirators would deposit them at storefront check-cashing businesses and take weekly deliveries of hundreds of thousands of dollars in cash.

As a Miami fraud criminal defense attorney, I was interested in this news because Medicare fraud may be the most common type of fraud against the federal government. And law enforcement says the three counties closest to us -- Miami-Dade, Palm Beach and Broward -- are among the top counties nationwide for Medicare fraud. In fact, the Florida Legislature just passed a law increasing penalties for defrauding the state Medicaid program. And Florida congressmen have been the driving force behind similar efforts to strengthen the federal anti-fraud law that the conspirators in this case have violated. With the economy in bad shape and government agencies looking for ways to trim fat painlessly, South Florida Medicare providers would be well-advised to expect further crackdowns.

As a Fort Lauderdale fraud criminal defense lawyer, I wish regulators well in their efforts to root out genuine fraud, especially organized schemes to defraud like the one described in the Herald. However, I would also be concerned for the patients and doctors who may be caught up in such a crackdown. Medicare fraud schemes frequently take advantage of patients who are elderly, unwell or otherwise vulnerable to exploitation. While there are some “patients” who are part of the schemes, many others are guilty only of trusting too much. And a few doctors may be vulnerable to Medicare fraud charges as well, thanks to a prohibition on “self-referral” and the general complexity of the system.

I absolutely support efforts to root out Medicare fraud -- but not at the expense of justice. Medicare fraud is a felony on both the state and federal levels, carrying up to 30 years in prison and six-figure fines at its most serious. As a South Florida fraud criminal defense attorney, I would not want those penalties levied at defendants who are already victims themselves.