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.