Please E-mail suggested additions, comments and/or corrections to Kent@MoreLaw.Com.
Case Number: 1:20-cr-00151-PLM
Judge: Paul L. Maloney
Court: United States District Court for the Western District of Michigan (Kent County)
Plaintiff's Attorney: United States District Attorney’s Office
Description: Grand Rapids, Michigan health care fraud charge criminal defense lawyer represented Defendant, Kenneth Nash, the owner of a South Haven home health agency, who was health care fraud. He admitted that his company, Universal Home Health Care, submitted claims for home health services totaling more than $750,000 when no physician had approved the services but, instead, employees forged physician signatures at Nash’s direction and with his knowledge. The federal investigation further revealed that Universal also billed Medicare for services that were not provided and that were medically unnecessary, as some of the patients were not homebound.
Upon the execution of federal search and seizure warrants in June of 2018, Nash closed the business and forfeited two Mercedes Benzes, a Land Rover, an Aston Martin, a Jaguar convertible, and a motorhome that had been purchased with proceeds from the fraud. In imposing a sentencing at the high end of the sentencing guidelines, Judge Maloney noted that Nash had a history of prior fraud convictions, that this offense involved a large loss to a government program, and that other health care providers needed to be deterred from defrauding Medicare.
U.S. Attorney Andrew Birge noted that “This sentence should serve as a warning to others in the health care industry that fraudulent billing has significant consequences. Mr. Nash has had to give up all he gained from his scheme and now his freedom as well.”
“Healthcare fraud is not a victimless crime,” said Lamont Pugh III, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “Medically unnecessary services can adversely impact a patient’s well-being and false and/or fraudulent billings waste limited tax-payer dollars that support federally funded programs such as Medicare and Medicaid. The OIG will continue to work to identify, investigate and hold accountable those who choose to engage in these criminal acts.”
“This sentence sends an unambiguous message that those who cheat Medicare will be held accountable," said Timothy Waters, Special Agent in Charge of the FBI in Michigan. "These taxpayer-funded programs are designed to provide essential medical services to the elderly, not to enrich corrupt health care professionals and other fraudsters."
The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, and the U.S. Attorney’s Office for the Western District of Michigan. Assistant U.S. Attorney Raymond E. Beckering III represented the United States.
18:1347(a)(1) HEALTH CARE FRAUD
(a) Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—
(1) to defraud any health care benefit program; or
(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program,
in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.
(b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.
Outcome: Defendant sentenced to 63 months in custody followed by 3 years supervised release; shall pay $755,628.52 restitution and $100 special assessment