Medicare Fraud Arrests in Los Angeles

May 3, 2012  •  Jerod Gunsberg, Los Angeles Criminal Defense Lawyer

The feds are getting serious about Medicare fraud.

More than 100 people have been charged in connection a Medicare fraud conspiracy that is alleged to span eight cities. Eight of the suspects are in Los Angeles, including two doctors.

According to news reports, more than $20 million in fraudulent medical expenses were billed just by the defendants in Los Angeles:

“All told, 108 doctors, nurses and other healthcare providers from around the nation were charged. In Los Angeles, authorities said defendants had filed $20 million in false claims.

Bolademi Adetola, owner of the Latay Medical Services company in Gardena, was charged with billing Medicare for power wheelchairs that never were purchased. The Greatcare Home Health group allegedly paid “kickbacks” to recruiters to find “patients” who were in good health, and then arranged to have doctors knowingly write phony prescriptions for them.

In addition, [two doctors]  were among four individuals connected with a Southern California medical care group that authorities say billed Medicare for feeding tubes for patients who did not need them.”

The allegations described above may sound extreme, but as a criminal defense lawyer, I can sssure that they are fairly typical for Medicare fraud cases.  Medicare fraud is a specific form of lying.  It is motivated by a desire to obtain reimbursement for medical expenses to which one is not entitled.  One common way to do this is to submit claims for medical procedures or services that were not performed.  Another involves paying third parties to find patents who then seek medical treatments that they don’t need.  A third involves submitting claim forms that identify a higher-cost service than was actually performed.

Medicare is a program that is administered by the federal government. Medicare fraud cases, unlike the vast majority of crimes, are therefore handled in federal court, which has its own rules, judges, prosecutors, and juries.  That’s why it’s imperative that you work with a lawyer who is experienced in defending criminal cases in federal court.

Unlike many criminal cases, Medicare fraud cases can also be document intensive.  Prosecutors often rely on written evidence –the claim forms submitted to Medicare—to try to prove guilt beyond a reasonable doubt.  In a case with more than 100 defendants, prosecutors may try to get lower-level individuals to testify against perceived ring leaders.  It is also possible that law enforcement may have obtained recording of certain conversations.  Thus, when defending a Medicare fraud case, particular attention needs to be given to the evidence that the prosecutors use with respect to every claim submitted to Medicare.

The penalties for Medicare fraud can be severe.  If someone is found guilty of intentionally providing false information in violation of The False Statements Act (18 U.S.C. 1001), they can face up to five years in jail as well as a sizeable fine.  Under the federal sentencing guidelines, the prison time can be higher depending on the amount of loss.  Likewise, the Social Security Act contains an anti -kickback provision, which makes it a felony to pay kickbacks, refunds, or bribes to seek Medicare reimbursement. Penalties for violating the anti-kickback provision include up to a five-year prison sentence and up to a $25,000 fine. People charged with Medicare fraud may also be charged with violating the federal wire and mail fraud statutes, which carry their own prison sentences and fines.

Given the number of people arrested in this particular case, it is likely that the prosecutors will be seeking extremely long prison sentences against the people who they perceive to be the ”big fish.”

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