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Miami Medical Clinic Owner Sentenced to Eight Years in Prison for Defrauding Medicare

The government is continuing to send the message that people who defraud its healthcare programs will not only face fines but will also face prison time. The Justice Department proved this again earlier this month when it announced that Vladimir Prado Sr., the owner of a Miami medical clinic, has been sentenced to 97 months in prison for his part in a $10 million healthcare fraud scheme involving a home health clinic and two physical rehabilitation clinics. Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division made this announcement in conjunction with cooperating agencies include the FBI, the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG), U.S. Secret Service’s (USSS) and local Miami officials.

Prado, who was sentenced by U.S. District Judge Robert N. Scola, is scheduled to serve three years of supervised release following his sentence. Prado and several co-defendants in the case have also been ordered to pay $4,001,499 in restitution. The charges against Prado are one count of conspiracy to commit health care fraud and wire fraud charged. The government says that Prado admitted to owning a Miami medical clinic through which he submitted nearly $5 million in false and fraudulent claims to Blue Cross Blue Shield. These actions resulted in payments to the clinics that totaled approximately $2.6 million.

These actions were also are in direct violation of the False Claims Act which seeks to protect government agencies from fraud and abuse and which helps protect the beneficiaries of healthcare programs such as Medicaid and Medicare. During his trial Prado admitted the he:

  • Used money from his activities to purchase a fraudulent home health agency
  • Submitted to the Medicare program, via interstate wires, approximately $2.2 million in claims for reimbursement
  • Submitted claims for benefits that was medically unnecessary

As a result of Prado’s fraudulent activities, Medicare infused his home health agency with approximately $3.9 million. This case was investigated by the Medicare Fraud Strike Force which operates in nine locations nationwide. Its mission is to deter and prevent fraud. Since its inception the Medicare Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion. One tool it has used to accomplish this is qui tam or whistleblower provisions of the False Claims Act. These provisions allow private citizens to sue for false claims on behalf of the government and to share in any recovery. Qui tam Medicare cases are often brought about by the former employees of companies that are alleged to have committed fraud. A whistleblower law firm helps protect the rights of such witnesses.