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Verdict and 30 years sentence in Medicare fraud trial upheld; United States v. Mateos


The Justice Department has directed federal law enforcement to make Medicare fraud a top priority. As a result South Florida has been the a hotbed of Medicare fraud indictments for the past several years. In this Medicare fraud trial, the evidence was sufficient to uphold a jury verdict involving a scheme to give false HIV positive diagnosis and dispensing medicine not medically necessary. Defendants were a doctor and a nurse who worked at an HIV clinic where patients were falsely diagnosed as having HIV positive. Medicare was falsely billed for treatment of WinRho, an expensive drug reimbursable by Medicare at a rate of $4,900 per treatment. The defendants at trial claimed no knowledge of the fraud. They appealed trial and sentencing issues.

Both defendants argued a lack of sufficient evidence to convict. The doctor’s conviction was upheld based on the circumstantial evidence showing she had knowledge of the scheme, altered patient charts, and her presence in the office when “professional” patients screamed for more money. The jury was entitled to draw a reasonable inference of guilt from the evidence and to disbelieve the doctor’s testimony she did not know the treatments were not medically necessary.

Exculpatory tape recorded statement by a codefendant to the defendant was not hearsay though its exclusion was harmless error.

At her trial, the doctor offered an exculpatory tape recorded statement made by a codefendant to the doctor assuring the doctor that there was no fraud taking place in the clinic. The trial court excluded the evidence on hearsay grounds but the court of appeals found the evidence was incorrectly excluded because it was not offered to prove the truth of the contents of the recording.

Rather, it was offered as evidence that the doctor did not know of the fraud. Nevertheless, the error was harmless because the exculpatory content of the tape was effectively admitted through witness testimony.

The Maximum sentence of 30 years for the Medicare fraud conspiracy was upheld. The doctor was sentenced to the maximum of 30 years, eight years more than the top end of the guidelines. The court of appeals found the sentence was reasonable in light of the reasons given by the sentencing court: punishing a doctor more severely for abusing her position of trust, the conspiracy sustained over a period of many months, the lower standard of care given to HIV positive patients, the need to promote deterrence of Medicare fraud, the defendant lied on the stand, and the lack of remorse.

The Swartz Law Firm handled one of the longest Medicare fraud trials in the South Florida that involved charges against physicians, pharmacists and durable medical equipment providers.