Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets.

Sila Luis received an 80-month prison sentence in addition to being ordered to pay $45 million in restitution.  This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze assets belonging to her that were not tied to the alleged fraud scheme.  This decision has the effect of making it more difficult for law enforcement authorities to swoop in and seize all assets of a suspect, effectively depriving them of the resources to even hire an attorney (which is a common tactic in such cases).

“Innocent” Property Can’t Be Seized.

In the 2016 Supreme Court decision, Chief Justice John Roberts and Justices Stephen Breyer, Ruth Bader Ginsburg and Sonia Sotomayor, voted to overturn the Eleventh Circuit Court of Appeals decision that the government could freeze Luis’ “innocent” assets as well as the ones directly traceable to the Medicaid fraud funds.  Justice Clarence Thomas concurred in a separate opinion.

“We conclude that the defendant in this case has a Sixth Amendment right to use her own ‘innocent’ property to pay a reasonable fee for the assistance of counsel,” Justice Breyer wrote for the plurality. “On the assumptions made here, the district court’s order prevents Luis from exercising that right.”

Under federal statute, the government is allowed to freeze some assets before trial in criminal cases alleging federal health care or banking violations, according to the ruling. However, the Justices agreed with the defendant that the freeze o f all her assets kept her from paying her attorney.  This by itself will usually force a guilty plea even from someone who may be innocent.

Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients.  She allegedly paid the patients to use one of her home health companies so that she could bill the government for unnecessary or unprovided services.  To read more on the U.S. Supreme Court’s decision, click here.

To read the judgement of the case in full, click here.

To read about another case of Medicare fraud in Florida, click here to read one of my prior blogs.

My Observations on this Case.

The power of pretrial seizure of assets is a very heavy handed tactic that I have seen used a number of times by law enforcement authorities, often, in my opinion, completely wrongfully.  In some cases it is used as a hammer to try to bludgeon the suspect to death.  In others it may be motivated by something as simple as a sheriff’s deputy deciding he really liked the defendant’s car and wanted to seize it.  I have seen the bank accounts of minor children sized when all they contained was what the child had worked for at a part time job to help pay for college.  I have seen an annuity fund seized which had been paid for ten years before any of the criminal activity allegedly took place.  I have seen cash taken from a mother (the wife of the alleged suspect) going into the delivery room at a hospital to give birth, when the cash had just been given to her by her mother to pay the hospital bill. I have seen law enforcement hold out in negotiations to return wrongfully seized property because what they really wanted was the suspect’s new Cadillac to use. Pre-trial seizure is an extremely powerful tool that can be easily misused.

So I can understand the U.S. Supreme Court’s decision in this case. On a slightly different topic however, I never cease to wonder at the small (relatively speaking) sentences that are given to the largest crooks.  I have seen poor people who could not feed their families sentenced to similar prison terms for merely a few thousand dollars in Medicaid or food stamp fraud.  Yet here someone bilks us, the taxpayers, out of $45 million and only gets only 80 months?  Let’s see.  That’s getting paid $562,500 per month for every month in jail.  Gosh, I bet there are some pretty rich people around who don’t make $562,500 a month. Typically, we find out that these people have their millions stashed overseas in secret foreign bank accounts.  Do several years in prison, get out, and then vanish overseas to Cuba or elsewhere and live like a king (or queen) for the rest of their lives.  The story seems to happen over and over again.

Maybe the key should be to make the sentencing guidelines give one month of prison times for every one hundred thousand dollars stolen.  Then reduce that prison time by one month for every one hundred thousand dollars that is paid back in restitution.  This promotes prompt restitution while ensuring that the convicted defendant does not get out only to flee somewhere to enjoy their stash of hidden funds.  This means, of course, that the Bernie Maddofs never get out (as should be the case), but at least the smaller offenders are nor being punished disproportionately to the larger ones.

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses.  In many cases, those subject to Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter.  Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare audits.

The government is serious about combating health care fraud.  It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs.  False claims are a growing problem in the program, costing the government billions of dollars each year.  Accordingly, punishments for defrauding the system can be quite severe.

If you have assets seized by state or federal law enforcement authorities, you must act immediately to start the proceedings to have them released or you may forfeit them.  There are often a number of valid defenses to have your property released.  The Health Law Firm represents individuals, spouses and families in obtaining the release of “forfeitures” and seized property and funds.

If you are accused of Medicare or Medicaid fraud, realize that you are in a fight for your life.  Your liberty, property/possessions and profession are all at stake.  Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines.  If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison.  Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.  They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Macagnone, Michael. “Fla. Woman Gets 6.5 Years, Owes $45M For Medicare Fraud.” Law360. (November 22, 2017). Web.

Koenig, Bryan. “High Court Determines ‘Untainted’ Assets Can’t Be Frozen.” Law360. (March 30, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Legal representation for Medicare fraud, legal representation for health care fraud, legal representation for Medicare audits, Medicare audit defense, legal representation for Medicare billing, health care clinic fraud audit, Medicare fraud defense attorney, health care fraud defense lawyer, health care fraud scheme, Medicare fraud scheme, civil forfeiture defense attorney, The Health Law Firm, legal representation for Medicare fraud investigation, civil forfeiture defense lawyer, legal representation for fraudulent billing, legal representation for improper billing, restitution for health care fraud offense, Medicare reimbursement claims, improper Medicare billing claims, false claims defense attorney, legal representation for Anti-Kickback Statute (AKS), AKS defense attorney, legal representation for accepting kickbacks, The Health Law firm attorney reviews, reviews of The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

 

 

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Florida Ophthalmologist Blinded by Greed-Accused of $7 Million in Medicare Fraud

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An Orlando ophthalmologist is accused of performing unnecessary laser-eye surgeries on numerous patients and submitting $7 million in false claims to Medicare. The eye doctor was indicted on April 24, 2014, on 20 counts of Medicare fraud by a federal grand jury in Jacksonville, according to the Orlando Sentinel. If convicted, the ophthalmologist could face life in prison.

Click here to read the entire article from the Orlando Sentinel.

The ophthalmologist’s practices are located in Leesburg and Orlando.

Charges Against the Ophthalmologist.

According to the Orlando Sentinel, the ophthalmologist is accused of falsely diagnosing patients with macular degeneration, a progressive eye disease that can lead to blindness. He allegedly performed laser surgery needlessly and provided unnecessary follow-up care to at least 20 patients. The indictment stated the eye doctor used the laser for treatment at such a low level for the patients that the work had no impact. This scheme allegedly spanned from 2000 until 2011.

And that’s not all. The eye doctor is also accused of falsifying medical records and billing other insurance companies for similar unnecessary procedures.

Records show state health officials suspended the ophthalmologist’s access to collect from Medicare and Medicaid in 2013, after investigating three malpractice complaints against him.

Losing His Luxuries.

As part of the criminal case, federal authorities have filed paperwork to seize the eye doctor’s four homes in Orange County, his Lexus and his Porsche convertible, according to The Florida Times-Union.

To read The Florida Times-Union, click here.

The civil forfeiture of property has become a popular tool for state and federal agencies to combat alleged criminal activity. In Florida, the Florida Contraband Forfeiture Act, Sections 932.701 through 932.706, Florida Statutes permits the government to seize personal property if there is probable cause to believe that property is either an instrumentality or the proceeds of criminal activity.

To read more on how the civil forfeiture of property and money is being used, click here to read a previous blog.

Eye Doctors Seeing Red After Medicare Reimbursement Data Released.

In April 2014, the government released records of Medicare reimbursement payments made to healthcare providers. Ophthalmologists ranked fourth among the highest-grossing Medicare recipients in Florida. To read my previous blog on reasons why ophthalmologists rack up more Medicare bucks, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at http://www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Do you have any personal experience regarding improper billing or false diagnosing? Please leave any thoughtful comments below.

Sources:

Stutzman, Rene. “Orlando Eye Doctor Accused of $7 Million in Medicare Fraud.” Orlando Sentinel. (May 6, 2014). From: http://articles.orlandosentinel.com/2014-05-06/news/os-david-ming-pon-medicare-theft-20140506_1_medicare-fraud-macular-degeneration-laser

Schoellter, Jim. “Judge in Jacksonville Orders Ophthamologist Held in $7m Fraud Case Involving Hundreds of Seniors.” The Florida Times-Union. (May 6, 2014). From: http://members.jacksonville.com/news/crime/2014-05-05/story/judge-jacksonville-orders-ophthamologist-held-7m-fraud-case-involving#ixzz30w2cFtT4

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

South Dakota Optometrist Settles Health Care Fraud Claims

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A South Dakota optometrist reached a settlement with the South Dakota Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU), and the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG). The optometrist will be shelling out $283,499 to resolve allegations he submitted false claims to Medicare, Medicaid and TRICARE, according to the South Dakota AG. This settlement was announced on October 1, 2013.

Click here to read the press release from the AG.

Optometrist Will Pay Fine and Sign Integrity Agreement as Part of the Settlement.

According to the AG, the optometrist allegedly submitted false claims to the health care programs for bifocal lenses, trifocal lenses and new patient visits. He is also accused of billing Medicare, Medicaid and TRICARE for medically unnecessary visual field examinations from June 2006 until December 2012.

On top of the fine, the optometrist will also sign an Integrity Agreement with the HHS, OIG. In the agreement, the optometrist will provide free eye care to underserved patients for one year, according to an article in Rapid City Journal.

Click here to read the Rapid City Journal article.

Responding to a MFCU Investigative Subpoena.

This case against the optometrist was handled, in part, by the MFCU. The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program.  When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. Click here to read practice tips on how to properly respond to a subpoena.

Fraud Charges Need to be Taken Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Be prepared to give up whatever you have if you can avoid a conviction.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

South Dakota Attorney General. “Optometrist Settles Healthcare Case with South Dakota and United States.” South Dakota Attorney General. (October 1, 2013). From: http://atg.sd.gov/News/NewsReleases/NewsReleasesView/tabid/441/itemID/3251/moduleID/719/view/597/Default.aspx

Rapid City Journal Staff. “Optometrist Settles Case Involving Fraud Allegations.” Rapid City Journal. (October 1, 2013). From: http://rapidcityjournal.com/news/local/article_62eafa10-0c68-5240-aee5-97defb6627a5.html#.UkyGbJiR9mA.twitter

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.