$2.5 Million Medicare Fraud Scheme, 126 Month Prison Sentenced for Miami-Area Home Health Agency Administrator

$2.5 Million Medicare Fraud Scheme, 126 Month Prison Sentenced for Miami-Area Home Health Agency Administrator

In February Raciel Leon, administrator of a Miami-area home health agency, was sentenced to 126 months in prison for his involvement in a $2.5 million Medicare fraud scheme. In December 2016, Leon was convicted of numbers crimes after a two-week jury trial in the U.S. District Court, Southern District of Florida. The jury found Leon guilty of “one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the United States and pay and receive health care bribes and kickbacks.”

False and Fraudulent Claims

The Medicare Fraud Scheme occurred at two home health agencies in Miami-Dade County: Mercy Home Care Inc. (Mercy) and D&D&D Home Health Care Inc. (DDD). Leon served as the manager of Mercy, and as a billing employee for DDD. The evidence presented at trial demonstrated that Leon, along with his co-conspirators, used Mercy and DDD to submit false claims to Medicare. The false claims were based on services that were not actually provided, services that were not medically necessary, and for patients who were procured due to illegal kickbacks to doctors and patient recruiters. Prior to his arrest, Leon destroyed a kickback ledger and other evidence. Ten of Leon’s co-conspirators had already been convicted at trial or pleaded guilty in this case and other related cases.

Leon specifically submitted claims to Medicare for Mercy and DDD patients who were admitted into the home health care programs based on falsified medical documentation and forged prescriptions. Further, Leon backdated claims for medical services allegedly rendered years prior. He also filed claims for Medicare beneficiaries who were coached to say they needed home health care, when they were not actually homebound.

Ultimately, the prosecution introduced evidence at trial establishing that Medicare paid approximately $2.5 million for false and fraudulent claims submitted by Mercy and DDD between October, 2014 and June, 2015.

Medicare Fraud Strike Force

As we noted in our article Health Care Fraud Costs the U.S. Billions Each Year prosecutors are aggressively pursuing Medicare fraud cases. This case was investigated by the FBI and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and brought as part of the Medicare Fraud Strike Force.

In the ten years since its inceptions, the Medicare Fraud Strike Force has charged more than 3,000 defendants who collectively billed over $11 billion to the Medicare program.

Aggressive Prosecution of Medicare Fraud

Criminal charges for health care fraud are prosecuted aggressively. Conviction carries harsh penalties, including fines and imprisonment. If you have been accused of Medicare fraud you need an attorney who understands the tactics and procedures the government will use to obtain a conviction. You need an attorney who can combat aggressive prosecutors.

As a former health care prosecutor with the United States Attorney’s Office, Ashley D. Adams understands the government’s tactics and knows how to establish the best possible defense for your case.

Contact us or call now (480) 219-1366 for a case evaluation.

 

The attorneys at Ashley D. Adams, PLC handles federal criminal cases throughout the United States, including Arizona, Oklahoma, Utah, and California.