United States v. Posada

Posada, a licensed chiropractor, owned and operated Spine Clinics, a Medicare-enrolled provider. Posada was indicted for a scheme to defraud Medicare and other insurers by submitting fraudulent claims and falsely representing that certain health care services were provided. The prosecution presented evidence that Posada billed the insurers for deceased patients and services never performed, created fake files, and failed to document the actual services rendered. Witnesses from Medicare and an insurer testified regarding the thousands of claims submitted. Two physical therapists also testified about the services they performed for Spine Clinics, how they billed Posada, and that they never performed many of the services for which he charged. Convicted of 18 counts of health care fraud, Posada’s PSR indicated an offense level of 26, based on a $4,087,736 loss amount, and recommended a term of incarceration of 63-78 months. To calculate that amount the prosecution reviewed Spine Clinic's files and when no treatment documentation was present, the amount billed was treated as a loss. The prosecution credited Posada with treating 20 patients a day, three days a week every week during the period of the fraud. Posada argued for an estimate of 25-26 patients per day and a loss amount less than $3.5 million. The district court accepted the government’s calculation and found a loss amount of $4,087,736. The Seventh Circuit affirmed that amount and Posada’s 60-month sentence, noting that the calculation was supported by the evidence at trial. View "United States v. Posada" on Justia Law