Health care fraud attorneys will rarely see larger health fraud cases than the case involving Health Care Solutions Network (HCSN), which resulted in the arrest of 7 people last week in Miami, Florida. HCSN's medical director, Roger Rousseau, and six therapists were arrested for allegedly defrauding Medicare and Florida Medicaid out of more than $63 million.
According to the indictment, from roughly 2004 through 2011, director Rousseau and therapists Doris Crabtree, Angela Salafia, Liliana Marks, Ruben Busquets, Alina Fonts, and Blanca Ruiz all allegedly took part in committing various health care fraud schemes that included providing health services that were either unnecessary or not given, altering and fabricating medical records, and constructing false and fraudulent claims for services that, again, either unnecessary or not given.
Although the case against these HCSN employees is still currently under investigation, 18 USC § 1347 outlines the possible consequences if they are convicted of having committing health care fraud. Punishments include severe fines and imprisonment of up to 10 years, or both. In the event that serious bodily injury or death resulted as a consequence of the fraud, prison terms increase to 20 years or life, respectively.
The so-called "ringleader" of the HCSN health care fraud scheme, Armando Gonzalez, has already entered a guilty plea for conspiracy to commit health care fraud and money laundering. In February of 2013, he was sentenced to 24 years in federal prison and ordered to pay restitution of in excess of $28 million.
According to the FBI's "White Collar Crime" website, health care fraud is estimated to cost our country $80 billion annually with that figure rising every year. Because the loss is so high and the effects far-reaching, the federal government will continue to prosecute those persons suspected of defrauding either/both federal and private insurance programs.