The owner and two managers operating Billing USA, a medical billing company located in Little Havana, have been convicted of health care fraud. A federal prosecutor documented their fraudulent claims totaling $5,692,102 to the insurers Blue Cross and Cigna.
These bills represented fake medical procedures associated with a clinic in Little Havana. An email from the U.S. Department of Justice explained that this clinic and others would send paperwork known as super-bills to Billing USA. The billing company then entered the super-bill information into insurance claims forms. Billing USA collected 6 percent on all funds paid to medical providers by insurers. At times, Billing USA created the super-bills on behalf of client clinics. Clinics would then produce fake medical records to document the claims.
Convictions so far have included the Billing USA office manager on one count of conspiracy to commit health care fraud. The 45-year-old owner entered a guilty plea to the same charge and has been sentenced to eight years in prison and forfeited $1.8 million. The owner must also repay $2,110,173 to insurers. Another person involved in operations at the company also ran a similar scam through another billing company. A judge set his prison sentence at six years and five months for health care fraud totaling $2,278,702.
White-collar offenses are often federal crimes that can produce harsh sentences. A person accused of financial crimes like forgery, computer fraud or embezzlement could consult an attorney about building a defense strategy. An attorney familiar with financial transactions and criminal defense might find ways to challenge evidence. If charges persist, an attorney might broker a plea deal with a reduced sentence.