Industry News

Consultant Sentenced to Prison for Role in $63 Million Health Care Fraud Scheme.

The United States Department of Justice (DOJ) recently sentenced a Miami, Florida health care clinic consultant to 135 months in prison for her participation in a Medicare fraud scheme.  In January 2016, the DOJ convicted Nery Cowan of conspiracy to commit money laundering.  Court documents indicated that Cowan and the now-defunct Miami health clinic submitted approximately $63 million in false claims to Medicare for partial hospitalization program (PHP) services.

Trial evidence demonstrated the following:

  • Cowan billed for PHP mental health services that were never actually rendered;
  • Cowan directed and authorized kickbacks in exchange for Medicare beneficiary referrals;
  • Cowan and two co-defendants disguised kickbacks to shell companies that solicited Medicare beneficiaries from assisted living facilities, halfway houses, and drug courts as “outreach” and “marketing” payments; and
  • The PHP falsified medical records to support fraudulent claims, from which Cowan received a percentage of the reimbursement as compensation.

Additionally, the United States District Court of the Southern District of Florida ordered Cowan to pay a $100,000 fine.

The DOJ Justice News article is available at:

United States Department of Justice.  “Former Health Care Clinic Consultant and Biller Sentenced to 135 Months in Miami for Role in $63 Million Medicare Fraud Scheme.”  Justice News.  13 Apr. 2016.