In last week’s blog, we highlighted the fact that healthcare fraud remains a constant problem throughout the United States and throughout every medical discipline. The Allegiant Experts Blog has kept pretty close tabs on the goings-on in the large and ever-growing world of health insurance fraud. But, we must admit, we take a special interest in stories that emanate from our home state of Florida.

Late last month, the United States Department of Justice reported that a Miami-area home health agency administrator was sentenced to a whopping 126 months in prison for his role in defrauding Medicare of $2.5 million. According to the report, 42 year-old Raciel Leon was found guilty of “one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the United States and pay and receive health care bribes and kickbacks.”

Leon’s two-week jury trial was completed in December, but on February 24th, U.S. District Judge William J. Zloch of the Southern District of Florida passed down his sentence. Leon formerly managed Mercy Home Care Inc. and was also a billing employee for D&D&D Home Health Care Inc. – both based in Miami-Dade County. Evidence presented in the trial showed that, along with some cohorts, he submitted several false claims to Medicare.

As the report explains, the false claims “were based on services that were not medically necessary, not actually provided, and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters.” The beneficiaries of the claims submitted by Leon to Medicare were individuals who were admitted to either “Mercy” or “DDD” – but only as a result of forged prescriptions and falsified medical documentation.

As well, many of the claims were backdated services that were supposedly rendered several years prior. Leon also coached some off the beneficiaries to say that they were in need of services that were actually unnecessary. For example, some would have to claim that they were homebound when, in fact, they were not. “Leon also destroyed evidence, including a kickback ledger, prior to his arrest,” says the report.

In total, Leon received about $2.5 million for the false and fraudulent claims that he submitted to Medicare on behalf of Mercy and DDD between October 2014 and June 2015. No less than ten of Leon’s co-conspirators, by the way, previously pleaded guilty or were convicted in other trials filed in the Southern District of Florida.

The team of clinical experts, here at Allegiant Experts, is well aware that such instances of health insurance fraud are not exclusive to our beautiful state of Florida. This problem that makes Florida just a little less beautiful is a dilemma plaguing the rest of our country as well. It’s why we work so diligently to assist attorneys who try cases against perpetrators of healthcare fraud.

Are you an attorney who could use our help? For more information about our experience, expertise and how we may be able help your case, call us at 407-217-5831 or email us at info@allegiantexperts.com.