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$200M Medicare Scam
Two Miami-area patient recruiters, James Edwards and Nelson Fernandez, were sentenced to prison for their roles in a $200 million Medicare scam.
Edwards, 65, was sentenced to 84 months in prison, while Fernandez, 43, received 63 months behind bars. Both men were also ordered to pay restitution, with Fernandez handing over $13.1 million and Edwards contributing $4.1 million.
The scam involved recruiting Medicare beneficiaries for American Therapeutic Corporation’s (ATC) partial hospitalization programs. The two men admitted to serving as patient brokers for ATC, recruiting patients in exchange for kickbacks.
According to court documents, Fernandez caused $8 million in fraudulent submissions to Medicare and $14.7 million in another scheme, while Edwards caused $8.16 million and $4.1 million in separate schemes. Both men knew the patients they recruited were not qualified to receive treatment.
ATC’s owners and operators paid millions in kickbacks to assisted living facilities and halfway houses, and patient brokers, in exchange for delivering ineligible patients. The money was laundered through Medicare payments.
The scheme was uncovered in 2011, with 20 defendants charged in two indictments. 19 have pleaded guilty or been convicted, with one trial scheduled for October 2012.
The sentences were announced by Assistant Attorney General Lanny A. Breuer, U.S. Attorney Wifredo A. Ferrer, and other officials.
RELATED: Miami PA Gets 15 Years for $200M Medicare Scam
RELATED: Miami Assisted Living Owner Gets 37 Months for Medicare Fraud
Key Facts
- State: Federal
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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