Conspiracy to Pay Kickbacks and Conspiracy to Commit Health Care Fraud. Defendant owned three DME companies that submitted 59.9 million dollars in false Medicare claims for medically unnecessary orthotic braces. Defendant concealed ownership through shell entities and paid kickbacks to others disguised as marketing fees.
The defendant operated a complex scheme involving multiple durable medical equipment companies that submitted false claims to Medicare and engaged in kickback schemes. The fraud involved 59.9 million dollars in billed claims with sophisticated concealment through corporate restructuring and disguised payments.
The critical sentencing argument focused on the distinction between total billings and actual Medicare payments. Counsel successfully argued that the loss calculation should be based on what Medicare actually paid to the defendant, not what was billed to the government. This approach significantly reduced the loss amount used in the sentencing calculation and shifted the restitution obligation away from full billing amounts.
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