Articles Posted in Sentencing Guidelines

playing%20cards.jpgIt never ceases to amaze me when I am hired to represent a client at sentencing who has just been found guilty of Medicare fraud when they say to me, “You know Mr. Malove, I just didn’t see this coming.”

I don’t know what to tell these clients. At this stage of the game, I must admit that in my mind I wonder how they didn’t at least consider the possibility that a jury wouldn’t believe their version. Almost always I know their trial attorneys, who are among the best of the best. I am sure that these fine lawyers reviewed all of the government’s evidence with their clients and fully laid out the government’s theory of the case.

Yet, despite their attorney’s unequivocal advice to enter into a plea bargain with the government, you have got to wonder why most of these clients went to trial? Was it because the client was so much in denial (not the river in Eqypt) that they simply couldn’t grasp what the government was prepared to prove? Or that that they just couldn’t bring themselves to admit to themselves or to their families that they had fraudulently obtained money from the government that they didn’t legitimately earn? Is it more than just denial? Bravado? Machismo? Whatever it is, one thing for certain – the decision to go to trial in many, if not most, of these cases flies in the face of the statistics. We’ve all heard it before: numbers don’t lie!

infusion.jpgAccording to a Department of Justice press release, Miami-Dade County resident Dulce Briceño was sentenced on February 4th to 63 months in prison for her role in a $2.3 million Medicare fraud scheme.

Miami based U.S. District Judge Ursula Ungaro also ordered Briceño to pay $1.8 million in restitution. Originally, Briceño was indicted in the Eastern District of Michigan, but after her arrest in Miami, she consented to have her case transferred to the Southern District of Florida for her plea and sentencing.

Briceño pleaded guilty on Oct. 9, 2009, at which time she admitted that in approximately September 2006, she agreed with the owners of X-Press Center to manage the clinic on a day-to-day basis in exchange for a percentage of the profits the clinic generated. Briceño also admitted that during the time the clinic was open, the clinic routinely billed the Medicare program for services that were medically unnecessary or were never provided. Briceño admitted that she and her co-conspirators at the clinic had purchased only a small fraction of the medications that the clinic billed the Medicare program for providing.

courtroom.jpgHOUSTON – Whether it is known as “courtroom rent” or by some other name, the dangers of going to trial as opposed to pleading guilty requires a careful consideration of the case, the facts, the sentencing guidelines and the judge.
Two Texas DME owners learned the very hard way yesterday at their sentencing following a trial. Rhonda Fleming was sentenced to 30 years in prison for her role in a DME scheme, she was the alleged owner of three DME companies and a billing company that submitted the claims, totaling $36 million. Her trial co-defendants, a co-owner of one DME and a “runner” (someone who supplied patient information for the others in the scheme) were sentenced to 11 years 3 months and seven and a half years in prison. Their co-defendants, who plead guilty before trial and testified at trial received 12 months, 60 months and 70 months in prison.
For more info, click: here.

viagra_pills.jpgOften, we hear that white collar crime is treated differently than other types of crime. However, it is often who commits white collar crime that brings about different treatment. I had a client indicted for fraud related to a DME. Monthly, he would send me articles about large DME companies paying large fines and false claims settlements for the same conduct he was alleged to have engaged in and asked the simple question, “Why am I supposed to go to jail and they don’t?”

People arrested for crimes, and in particular health care fraud can find many rationales for conduct that objectively looks bad; some form the bases for defenses; some are to try to feel better. One reaction is generally the same for nearly all, whether it is speeding or a million dollar fraud, “everyone is doing it.” A variation on that theme, and a fair one is that often individuals and small companies are treated much differently than much larger companies.

In 2004, at the same time Pfizer was negotiating a resolution of a $460 million settlement with the United States for unlawful “off label” uses of its drugs, it also was planning and executing marketing campaigns for other drugs doing precisely the same conduct. The results, a huge fine and restitution, but no criminal charges for individuals. An individual that takes a million dollars in a Medicare fraud scheme is going to jail; as are employees and others most closely associated with that person and the scheme. The world’s largest drug company agreed it participated in a $1 billion in Medicare fraud and pays money. The company, or likely a subsidiary, also plead guilty to a crime, but no person goes to jail. $2 billion is not a small sum, but many sitting in prison wonder why the rules are different.

infusion.1.jpgEight Miami-Dade County residents have been charged in a 16-count indictment for their alleged roles in a Medicare fraud scheme involving fake HIV infusion treatments.

After the arrests, the Sept. 24, 2008, indictment was unsealed charging one count of health care fraud conspiracy against Juan A. Marrero, a/k/a Tony Marrero; Orlando Pascual Jr.; Belkis Marrero; Dr. David Rothman; Luz Borrego; Dr. Keith Russell; Eda Milanes; and Jorge L. Pacheco.

moneylaundering.jpg.gifIn addition to the conspiracy charge, Tony Marrero is charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Pascual is also charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Belkis Marrero is additionally charged with six counts of health care fraud, one count of money-laundering conspiracy and one count of money laundering. In addition to the conspiracy charge, Rothman and Borrego are each charged with four counts of health care fraud, and Milanes, Russell and Pacheco are each charged with two counts of health care fraud. The indictment also seeks forfeiture from all defendants.

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DALLAS, TX (August 27, 2008) – The federal government’s largest health fraud case involving online pharmacies was scheduled to conclude today with the sentencing of Ryokesh Johar Saran (Joe Saran) before US District Judge Jorge A. Solis in the Northern District of Texas. Saran as well and the 30 corporations he controlled were scheduled for sentencing. Sentencing for the corporate and individual defendants was indefinitely postponed due to the apparent heart attack Saran suffered en route to court.

Benson Weintraub, the nationally renown federal sentencing expert and a former full-time professor of law along with publisher of the Health Care Fraud Blog, Robert Malove, both of Fort Lauderdale have represented Saran and the corporate defendants for more than two-years and have been mounting a virtually unprecedented course of complex presentece litigation. The defense has challenged the criminalization of Group Purchasing Organizations (GPO), comparing it to “pharmaceutical arbitrage” according to recent defense pleadings.

The United States Circuit Court of Appeals for the Eleventh Circuit in Atlanta reversed one of my cases on July 31, 2008, and remanded it back to the district court for re-sentencing due to the sentencing judge’s failure to specifically follow the dictates of 18 U.S.C. § 3553(c). While this particular case had to do with a conspiracy to import a large quantity of cocaine aboard a ship boarded by customs agents on the high seas, the appellate court’s opinion has universal applicability to all federal sentencing matters and certainly must be paid careful attention by attorneys who represent healthcare fraud defendants at sentencing. To read the opinion click here.

Headshot.jpgMIAMI (July 11, 2008). Yesterday the Bureau of National Affairs first reported another case rejecting the government’s methodology of computing “loss” in health fraud cases under the federal sentencing guidelines in the Southern District of Florida.

BENSON WEINTRAUB, the nationally renown federal sentencing expert National sentencing expert, a former full-time professor of law, persuaded US District Judge Cecilia Altonaga to reduce the government’s overarching figure of $14 million down to less than $400,000. The sentence of 41 months was about half of what the government claimed should be applied under the sentencing guidelines.

This ruling adopted the legal rationale of Judge Adalberto Jordan reported earlier in this blog when he declared that he didn’t care whether the government proved the “submitted” amount as “intended loss” when the law actually requires calculation of the “allowed amount” minus 80 percent.

BENSON WEINTRAUB, the nationally renown federal sentencing expert and ANTHONY C. VITALE of the Health Law Offices of Anthony C. Vitale, PA presented a novel issue in health care fraud during a 5-day sentencing proceeding against Rodolpho Ramirez, a DME operator sentenced by US District Judge Adalberto Jordan (S.D.Fl.) to 24-months imprisonment for making fraudulent claims to Medicare and paying kickbacks to a local physician.

Weintraub and Vitale were successful in persuading Judge Jordan to assume, without deciding the issue, that an obscure provision of “Special Rules” in the calculation of loss under the Federal Sentencing Guidelines is instructive and resulted in a significant exclusion of “relevant conduct” claimed by the government and a Guideline range approximately half of that requested by John Cunningam and Jay Darden, DOJ Trial Attorneys from the Fraud Section in Washington.

The case attracted considerable attention in the legal profession with both criminal defense lawyers and a Deputy Attorney General observing portions of the extraordinarily lengthy hearing characterized by expert medical testimony about medical necessity, Medicare billing procedures, and medical economics.

By

Benson Weintraub [Benson Weintraub is a sentencing lawyer is Of-Counsel to the Law Offices of Robert David Malove, P.A.,in Fort Lauderdale and former Visiting Professor of Law at Hofstra University. While in law school, he worked on the Hoffa litigation under the direction of civil rights lawyer, Leonard Boudin.]

The political implications of Lewis Libby’s commutation of sentence by President Bush continue to reverberate, but this case summons lewis-libby.jpg memories of the suspicious circumstances hoffa.jpg under which President Nixon commuted the sentence of former Teamsters President, James R. Hoffa, 1971.