In The News

Florida Man Convicted in Multimillion-Dollar Health Care Fraud Scheme

The government’s crackdown on Medicare and Medicaid fraud has uncovered some very elaborate schemes resulting in millions of dollars in losses for those agencies. This was demonstrated this week when the Justice Department and several other agencies including the FBI and HHS, announced that a jury had convicted the owner of Gold Care Home Health Services – a home health agency based in Florida – for his participation in a health care fraud and money laundering scheme involving Medicare. Specifically, the defendant – Pilar Garcia Lorenzo – was convicted by a jury of conspiracy to commit health care fraud and wire fraud and conspiracy to commit money laundering. Sentencing in the case has been scheduled for Jan. 5, 2017.

According to evidence brought forth by the government, Gold Care submitted millions of dollars worth of false claims to Medicare during the summer of 2014. The claims were for services that had never been provided nor legitimately prescribed by a physician. These fraudulent claims, it is alleged, resulted in Medicare reimbursing Gold Care for approximately $2.5 million. Moreover, the government proved that Garcia used a “straw” owner in order to execute and conceal her fraudulent activity. As for the money laundering charges, the evidence showed that Garcia moved $2 million of Medicare monies through a shell company located in Hialeah, Florida by way of cash transactions.

The case was investigated by the FBI and HHS-OIG as part of the Medicare Fraud Strike Force and other cooperating state and federal agencies. The Medicare Strike Force, which was formed in March of 2007, has charged nearly 3,000 defendants in cases involving Medicare fraud. Collectively those defendants have billed Medicare over $10 billion. Defendants who have been accused of healthcare fraud should contact a False Claims Act lawyer for representation. It is the job of a False Claims Act attorney to give counsel to defendants in such cases. If, on the other hand, you know of fraud that has been committed against the government or one of its agencies, you are encouraged to report it at