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Thursday, January 14, 2016

Health Care Clinic Consultant and Medicare Biller Pleads Guilty in Miami for Role in $63 Million Health Care Fraud Scheme

A former health care clinic consultant and Medicare biller pleaded guilty today in connection with a $63 million health care fraud and money laundering scheme involving a defunct Miami-area health care 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 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, pleaded guilty before U.S. District Judge Beth Bloom of the Southern District of Florida to one count of conspiracy to commit money laundering.  Cowan will be sentenced by Judge Bloom on March 25, 2016.  

According to the factual basis, Cowan served as a consultant and Medicare biller for Greater Miami Behavioral Healthcare Center Inc. (Greater Miami), a partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness, where Cowan directed the payment of kickbacks to patient brokers and others in exchange for Medicare beneficiary referrals.  Cowan admitted that she received a percentage of the Medicare reimbursement from Greater Miami’s PHP as compensation.

Cowan 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.  Cowan, Butler and Mora disguised these monthly kickbacks as “outreach” or “marketing” payments through HNB-Stell Care Inc., a sham staffing company, she admitted. 

According to court documents, from 2006 through 2014, Greater Miami billed Medicare approximately $63 million for purported mental health services.

On Nov. 30, 2015, Judge Bloom sentenced Butler to 16 years in prison and Mora to nine years in prison following their guilty pleas.

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 Attorneys Elizabeth Young and Kelly Graves of the Fraud Section are prosecuting 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 & 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.  

Healthcare Fraud
Updated January 14, 2016