In a story we hear of all too often in South Florida, a Miami-area man was recently sentenced to 20 years in prison (240 months) for his role in a large Medicare fraud scheme. In addition, he is also required to pay $66.4 million in restitution for the fraud he committed against the Medicare system.
Rafael Arias thought that he was going to become rich by defrauding Medicare. He already owned at least eight houses, three cars, a meat supermarket, and many healthcare agencies in the area. However, between the years of 2007 and 2015, he was actively committing fraud against the Medicare system by using his health care clinics and co-conspirators to assist him in the cover-up of illegal activity.
Arias was the owner and operator of more than 20 home health agencies during that time period. In order to fraud the system, he recruited co-conspirators to act as owners and operators of the facilities in order to hide his true identity and his ownership. These "nominee" owners falsely and fraudulently represented themselves and are also implicated in the crime.
Additionally, Arias and his partners paid illegal bribes and kickbacks to patient recruiters so that they would refer patients to the agencies that he owned. He and his team also submitted false and fraudulent home health care claims to Medicare. In these claims, beneficiaries were mentioned who either didn't even qualify for the services charged to Medicare, or the services were never actually provided.
When he received payment from the government, he would provide checks to others to have them cashed, and he would take the funds for his own private use, or use the money to continue the fraudulent scheme.
Arias pleaded guilty to one count of conspiracy to commit health care fraud as well as wire fraud. He was sentenced to 20 years and ordered to pay back $66.4 million and forfeit gross proceeds obtained due to the offense. His homes, cars, and businesses, except for the health care agencies, were seized and used as partial payment for the restitution.
His co-conspirators received various degrees of lesser sentences, but all will spend time in federal prison. As patient recruiters and fake owners of the facilities, they were charged with conspiracy to commit health care fraud and wire fraud, as well as money laundering.
The FBI actively investigates suspected Medicare fraud, and South Florida always seems to be a hotbed for this type of criminal activity. All too often, we see fraudsters attempt to scam the system by illegally charging for services never rendered, or using patient recruiters and offering kickbacks, both of which are criminal activities.
If you are arrested and accused of a crime, you should contact an experienced criminal defense attorney immediately. Your attorney will be able to help you understand the charges against you and the best defense for your case.
Neal, D. J. (n.d.). He once owned a small world. He bought it with $66 million of Medicare fraud. Retrieved March 07, 2018, from http://www.miamiherald.com/news/local/community/miami-dade/article203731554.html
Owner of Numerous Miami-Area Home Health Agencies Sentenced to 20 Years in Prison for Role in $66 Million Medicare Fraud Conspiracy. (2018, February 28). Retrieved March 07, 2018, from https://www.justice.gov/opa/pr/owner-numerous-miami-area-home-health-agencies-sentenced-20-years-prison-role-66-million