Health care fraud schemes take many shapes, but a large majority of the schemes that have been discovered and prosecuted involve the same elements: a doctor who sees what appears to be an easy source of money, patients for whom the doctor will prescribe and perform essentially unnecessary medical procedures and then submit an invoice to Medicaid. Federal prosecutors in New York City recently announced a guilty plea in a similar case involving $31 million in fraudulent charges for unnecessary medical procedures.
The alleged fraudulent scheme
According to federal prosecutors, the defendants found numerous poor individuals who did not need immediate medical care. Nevertheless, the doctor prescribed various medical procedures on these fictitious patients even if they did not require any such treatment. The prosecutors alleged that most of the victims were very poor, were drug addicts, and were recruited from homeless shelters in furtherance of the scheme.
According to prosecutors, the so-called patients feigned slip-and-fall accidents. In many cases, no fall actually occurred, and the patient suffered no injury. Many doctors were allegedly involved in the scheme. Prosecutors said doctors gave personal loans to their “patients” to cover the cost of the medical treatment. Many of the loans had interest rates of 100%, and the doctors who made these loans recovered nearly all the proceeds of the slip-and-fall lawsuits.
Penalties
The main defendant agreed to forfeit $513,000 in proceeds from the fraudulent activity to the Federal government and to pay $3.98 million in restitution to the victims, including businesses and insurance companies. This individual will likely be sentenced to five years in prison.
While the details of this case may seem shocking, it’s important to remember that everyone who is accused of a crime has the right to a defense. Criminal defense attorneys can help the accused to understand their rights and legal options.