Federal Court Sentences Physician in Health Care Fraud Case

By Bill Branson (Photographer) [Public domain or Public domain], via Wikimedia CommonsA doctor pleaded guilty to multiple federal counts of health care fraud, money laundering, and conspiracy to pay and receive kickbacks in September 2014, shortly before his case was scheduled to go to trial. This summer, the judge sentenced him to 45 years in prison and ordered him to pay millions of dollars in restitution. The government commenced its case against the doctor with a complaint and indictment filed in August 2013. It filed multiple superseding indictments, culminating in one that listed 23 counts under five sections of Title 18 of the U.S. Code. United States v. Fata, No. 13-cr-20600, 4th sup. indictment (E.D. Mich., Jan. 15, 2014).

A prosecution for health care fraud requires proof beyond a reasonable doubt that a defendant intentionally used fraudulent or deceptive means to obtain something of value from a “health care benefit program” (HCBP), which includes both public and private health plans. 18 U.S.C. §§ 24(b), 1347. The defendant, who worked as an oncologist, was accused of submitting “false and fraudulent claims” to multiple HCBPs “for services that were not medically necessary.” Fata, indictment at 8. The HCBPs included Medicare, Blue Cross Blue Shield, and Aetna.

Prosecutors accused the defendant of ordering treatments and procedures for more than 500 patients, including chemotherapy, that they did not need in order to bill Medicare and private insurance providers. This included expensive medications and treatments for healthy patients falsely diagnosed with cancer and hospice-care patients who would not derive any benefit from further treatment. Many health care fraud cases involve reimbursement claims for treatments that never actually took place. This case, according to prosecutors, directly endangered patients’ health.

The initial indictment alleged one count of health care fraud, as well as criminal forfeiture under 18 U.S.C. § 982. Prosecutors filed several superseding indictments, the last of which alleged 19 counts of health care fraud covering a time period from November 2011 through July 2013. It also alleged one count of conspiracy to pay and receive kickbacks from a Medicare-funded program, 18 U.S.C. § 371; 42 U.S.C. §§ 1320a-7b(b)(1)(A), (b)(2)(A); one count of unlawful procurement of naturalization, 18 U.S.C. § 1425(a); and two counts of money laundering, 18 U.S.C. § 1956(a)(1)(A)(i).

The defendant pleaded guilty to 16 of the 23 charges in September 2014. Trial had been scheduled to begin on October 14. The plea included 13 counts of health care fraud, the conspiracy count, and the two money laundering counts. The federal government’s sentencing memorandum described the defendant as “the most egregious fraudster in the history of this country, measured not by the millions of dollars he stole but by the harm he inflicted on his victims.” Fata, sentencing memorandum at 11 (May 28, 2015). It requested the statutory maximum of 175 years or a life sentence in prison. In July 2015, the court imposed a sentence of 45 years.

These blog posts are meant to be illustrative only. Unless expressly stated to the contrary herein, these matters are not the result of any legal work of Michael J. Brown, but are used to communicate a particular point of view. Michael J. Brown does not claim credit for any legal work done by any lawyer or law firm either generally or specifically, with respect to the matters contained in this blog.

Board-certified criminal defense attorney Michael J. Brown has defended the rights of people in west Texas against state and federal criminal charges for more than 20 years. Contact us online or at (432) 687-5157 today to schedule a confidential consultation with a member of our team.

More Blog Posts:

Firearms Distributor Indicted for Mail and Wire Fraud for Alleged Bribes, Kickbacks, Texas Criminal Lawyer Blog, September 26, 2014

Texas Woman Convicted in Federal Court of Health Care Fraud, Including Several Conspiracy Counts, Texas Criminal Lawyer Blog, September 27, 2013

Owner, Three Employees of Defunct Pharr, Texas Medical Supply Company Accused of Wire and Health Care Fraud, Texas Criminal Lawyer Blog, July 10, 2012

Photo credit: By Bill Branson (Photographer) [Public domain], via Wikimedia Commons.