Florida men plead guilty to $67 million Medicare fraud scheme
The scheme involved genetic testing and durable medical equipment that patients did not need, which the defendants procured with kickbacks.
Photo: Blanchi Costela/Getty Images
Two Florida men pleaded guilty last week for their roles in a scheme to defraud Medicare by submitting over $67 million in false claims for genetic testing and durable medical equipment that patients did not need and that the defendants procured with kickbacks.
The pleas came after four days of trial in the Southern District of Florida.
According to court documents, Daniel M. Carver, 36, of Boca Raton, owned and managed call centers that he used to conduct deceptive telemarketing campaigns targeting Medicare beneficiaries to solicit them for unnecessary genetic testing and durable medical equipment. Louis "Gino" Carver, 32, of Delray Beach, worked for these call centers and acted as a straw owner for a laboratory that submitted false genetic testing claims.
The Carvers and their co-conspirators allegedly paid kickbacks and bribes to telehealth companies in exchange for completed doctors' orders, sold doctors' orders to laboratories and durable medical equipment companies in exchange for kickbacks, forged doctors' and patients' signatures, and tricked medical providers into ordering medically unnecessary genetic testing.
Between January 2020 and July 2021, the scheme resulted in the submission of over $67 million in false claims to Medicare for medically unnecessary genetic tests and durable medical equipment.
WHAT'S THE IMPACT?
Daniel Carver pleaded guilty to conspiracy to commit healthcare fraud and wire fraud, and conspiracy to defraud the United States and pay and receive kickbacks. He faces a maximum penalty of 25 years in prison. Louis Carver pleaded guilty to conspiracy to commit healthcare fraud and faces a maximum penalty of 10 years in prison.
Both men are scheduled to be sentenced on Dec. 5. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
In addition to last week's guilty pleas, five other defendants in this case have pleaded guilty and are awaiting sentencing. Three defendants are scheduled for a trial set to commence on Sept. 26.
Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department's Criminal Division, Assistant Director Luis Quesada of the FBI's Criminal Investigative Division, and Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.
The FBI and HHS-OIG are investigating the case.
THE LARGER TREND
Settlements and judgments under the False Claims Act exceeded $2.2 billion in the fiscal year that ended on September 30, more than $1.7 billion of which pertained to matters that involved the healthcare industry – including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations and physicians, the DOJ said in February.
The False Claims Act imposes treble damages and penalties on those who knowingly and falsely claim money from the federal government or knowingly fail to pay money owed to the United States.
The amounts included in the $1.7 billion reflect recoveries arising just from federal losses. In many of these cases, the department was instrumental in recovering additional amounts for state Medicaid programs, the DOJ said.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
