On February 24, 2009, U.S. District Judge Altonaga in Miami sentenced Jimmy A. Soto to 140 months' imprisonment for his participation in an alleged health care fraud and money laundering scheme. He was found guilty in December 2008 after a week long trial before a Miami jury.The evidence at trial established that Soto conspired with others in operating a durable medical equipment (DME) known as Med-Pro of Miami, Inc ("Med-Pro"). Med-Pro submitted $5.4 million in durable medical equipment (DME) claims during 2005 and 2006, and were paid approximately $1.3 million. The government contended that the claims were fraudulent and were for DME items that were neither prescribed by doctors nor delivered to Medicare patients, most of whom resided in the Treasure Coast area of Florida.
The money laundering conviction was based on evidence that Soto recruited his customers and friends to cash several hundred thousand dollars worth of checks for Med-Pro during 2006. The case came to the attention of the government after numerous Treasure Coast residents contacted the FBI to complain about Med-Pro's submission of fraudulent claims to Medicare.
Judge Altonaga previously sentenced Soto's co-conspirators as follows: (1) Eliades Diaz was sentenced to 80 months in prison; (2) Leonardo Lozada was sentenced to 46 months in prison; and (3) Jose D. Claro was sentenced to 31 months in prison.
Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov/
Commentary: Most of our clients are honest health care providers who are not concocting fraudulent schemes to defraud the government. These extreme cases, however, are good to remind us of the following.
First, sentences for health care fraud cases have gotten much longer. It is therefore critical to avoid ever being charged since the exposure for criminal charges is harsh. If charges are brought it is important to completely assess the issues at the very outset. If there is billing for services not provided or for medically unnecessary services, those cases do not usually get better with time. 1 word of advice: compliance. Put a compliance plan in place and make it operative.
Second, these fraud cases create pressure on the health care system where the government assumes that there is a layer of fraud in billing and services provided to beneficiaries. The government sees so many extreme cases that there is a jaded view of what is being provided to patients. This affects, for example, the way they approach honest providers during audits and interviews.
Third, do a background check on who you do business with in healthcare. If there were doctors who wrote prescriptions for DME and the doctors referred them to a company like Med-Pro – the doctor would be under investigation. It is important to deal with reputable businesses and individuals with a long history. The old saying of “if you lie down with dogs you’ll get fleas” applies here and can at least cause administrative problems. This is especially true in cities like Los Angeles, Miami and New York which have the highest concentration of health care fraud and where organized crime has infiltrated to a certain extent.
Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of individuals, businesses, licensed professionals, including health care professionals and providers, including individual physicians, corporate providers and group practices.
