When the Part D is Over


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Owning a home has long been part of the American Dream. But one 24-year-old’s ability to buy a couple of homes and numerous expensive cars cannot be attributed to hard work or even luck, but to a family fraud conspiracy of nightmarish proportions. (Wake up, would-be thieves!) According to the Miami Herald, the young pharmacy technician, who came to the United States from Cuba as a teenager, was the leader of a ring of relatives and others who stole nearly $21 million from the Medicare Part D program. .

According to court records, the scheme involved a network of eight separate Miami-Dade pharmacies controlled by the defendant, who was indicted along with 11 others including his mother and aunt. (His defense argued he was manipulated because of his age and sense of duty to family—keep dreaming.) The fraudsters fleeced the Medicare Part D prescription drug program by paying patients and patient recruiters for their Medicare ID numbers, then submitting false claims for unnecessary prescriptions which were never even filled. The patient recruiters received kickbacks, and the ringleader bought himself a Rolls Royce and a Bentley, to name a few purchases. (According to the article, the convicted pharmacy technician has refused to name all his assets, only admitting to stealing $5.5 million. Let’s give him a cheap cigar.)

The accused pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud. He was sentenced to nine years in prison and ordered to pay $20,988,632 in restitution. Other family members, including his mother and aunt, also arranged for plea deals for their parts in the conspiracy. (It’s now their family duty to pay for their crimes).

A joint investigation by the Federal Bureau of Investigation and the Office of the Inspector General for the U.S. Department of Health and Human Services led to a regional sweep of Medicare fraud suspects in South Florida that was part of a record-setting national Medicare fraud round-up. The dirty dozen in this case were among 70 in the region, which in turn made up about one-third of the national total.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Young Miami man gets nine years for stealing $21 million from Medicare,” written by Jay Weaver and published by the Miami Herald on December 9, 2015.

For Daniel Suarez, Medicare fraud was a family affair.

Suarez ran a ring of relatives who robbed $21 million from the taxpayer-funded Medicare program by using a network of Miami-Dade pharmacies to submit phony claims for costly prescription drugs.

On Wednesday, the convicted pharmacy technician, who emigrated from Cuba to the United States as a teenager, was sentenced to nine years in prison — significant punishment, but less than the 14 years federal prosecutors thought he deserved.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.