Former Health Care Clinic Consultant and Biller Sentenced to 135 Months in Miami for Role in $63 Million Medicare Fraud Scheme
A former health care clinic consultant and Medicare biller was sentenced to 135 months in prison and ordered to pay a $100,000 fine for her role in laundering money in connection with a $63 million health care fraud scheme involving a now-defunct Miami health provider.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.
Nery Cowan, 53, of Miami, was sentenced yesterday by U.S. District Judge Beth Bloom of the Southern District of Florida. Cowan pleaded guilty to one count of conspiracy to commit money laundering on Jan. 14, 2016.
As part of her guilty plea, Cowan admitted to serving as a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc. (Greater Miami), a partial hospitalization program (PHP) located in Miami, which purported to provide intensive treatment for the severely mentally ill. During the course of the scheme, Cowan directed and authorized the payment of kickbacks and bribes to patient brokers and others in exchange for Medicare beneficiary referrals, she admitted. Cowan also admitted that Greater Miami personnel routinely falsified medical records affiliated with these recruited Medicare beneficiaries to support false and fraudulent claims to Medicare. Cowan received a percentage of the Medicare reimbursement from Greater Miami’s PHP as compensation, she admitted.
Cowan also admitted that she, along with co-defendants Dean Butler and Irina Mora, took great lengths to conceal kickback payments to shell companies owned by “patient brokers” who, on behalf of Greater Miami, solicited Medicare beneficiaries from assisted living facilities, halfway houses and drug courts located throughout the Southern District of Florida. According to her plea, Cowan, Butler and Mora disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company.
On Nov. 30, 2015, Judge Bloom sentenced Butler and Mora to 16 years and nine years in prison, respectively, following their guilty pleas.
According to court documents, from 2006 through 2014, Greater Miami billed Medicare approximately $63 million for purported mental health services.
The FBI and HHS-OIG investigated this case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Southern District of Florida. Assistant Chief Allan J. Medina and Trial Attorney Elizabeth Young of the Fraud Section prosecuted the case.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.