Owner of Florida medical biller gets 8 years in prison for fraud scheme

The owner of Billing USA, a medical billing office in Miami, Fla., was sentenced to eight years in prison after pleading guilty for his role in a fraud scheme, according to the Miami Herald.

Mauricio Palma, owner of Billing USA, was sentenced after pleading guilty to conspiracy to commit healthcare fraud. Mr. Palma faces $2.1 million in restitution, and he lost $1.8 million in forfeiture.

Under the alleged scheme, Billing USA received or offered to create fabricated bills for its clinic customers. Clinics would submit patient information to the billing firm, and employees would bill insurance companies for allowable amounts, according to the report. Billing USA would then tell the clinic what it had billed insurers, so the clinic would create records to back up the charges. Billing USA collected a 6 percent fee on reimbursement from insurers.

According to court documents obtained by the Miami Herald, Billing USA, in concert with a local clinic, filed $5.7 million in fraudulent claims to Blue Cross Blue Shield. Billings USA and another clinic filed an additional $5.9 million in fraudulent claims to Blue Cross and Cigna, according to the report.

Billing USA's office manager, Francel Rodriguez, was convicted of one count of conspiracy to commit healthcare fraud Aug. 3. In addition, Rafael Izquierdo-Rios, who helped run Billing USA and allegedly used a similar scheme at his own billing company, American Fast Services, was sentenced to six years and five months in prison. The latter operation led to fraudulent payments of $2.3 million from Blue Cross Blue Shield, Cigna and UnitedHealthcare, according to the Miami Herald.  

More articles on legal and regulatory issues:
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