Two Florida men have been sentenced to federal prison for their roles in a $34.8 million Medicare fraud conspiracy that resulted in orthotic braces being shipped to beneficiaries who didn’t need or request them. Kenneth Charles Kessler III, 43, of Miami, was sentenced to 33 months in prison, while Michael Andrew Gomez, 43, of Miramar, received a 24-month sentence. Both men pleaded guilty in May to conspiracy to commit health care fraud. The Justice Department announced their sentences September 4.
The Men Operated Seven Medical Equipment Companies
According to court documents, Kessler and Gomez owned and operated seven Florida-based durable medical equipment companies. Prosecutors said the businesses submitted millions of dollars in false Medicare claims for medically unnecessary orthotic braces. The defendants paid illegal kickbacks and bribes to obtain fraudulent signed doctors’ orders and then used those orders to ship braces to Medicare beneficiaries across the country. Some beneficiaries neither requested nor needed the equipment they received. Kessler and Gomez then sought Medicare reimbursement for those braces.
Telemarketers Targeted Medicare Beneficiaries
The scheme also involved marketing operations targeting thousands of Medicare beneficiaries, according to the Justice Department’s earlier announcement of the case. Prosecutors alleged that marketing companies used deceptive and aggressive telemarketing to persuade beneficiaries to accept medical equipment they didn’t need.
Those companies allegedly obtained beneficiaries’ personal identifying information and worked with purported telemedicine companies to generate doctors’ orders for unnecessary equipment. The orders were then used by the defendants’ network of DME companies to bill Medicare. That makes an unsolicited call offering a “free” brace or other medical equipment more than an annoyance: beneficiaries should be cautious about giving callers their Medicare number or other personal information.
Prosecutors Say Billing Was Shifted Between Companies
The Justice Department says Kessler and Gomez didn’t rely on a single medical equipment company. When Medicare imposed payment suspensions, prosecutors said the men shifted fraudulent billing among their multiple DME companies to evade those restrictions. The government says Kessler personally profited by more than $1.4 million from the conspiracy. Gomez profited by more than $2.3 million. Together, that’s more than $3.7 million in personal profits attributed to the two defendants.
An Unexpected Brace Can Be a Medicare Fraud Warning
The case provides a practical warning for Medicare beneficiaries and their families. Someone who receives a brace, glucose monitor or other medical equipment they never requested shouldn’t assume the shipment is simply a harmless freebie. Beneficiaries should also review their Medicare statements for equipment, tests and services they don’t recognize. An unfamiliar claim could mean Medicare was billed using a beneficiary’s information even though the person didn’t request or medically need what was supplied. That’s especially important because protecting a Medicare number is similar to protecting other sensitive personal information: beneficiaries shouldn’t give it to an unsolicited caller simply because the person claims Medicare will pay for an item.
Check Your Medicare Claims for Charges You Don’t Recognize
Beneficiaries can review their Medicare claims through their Medicare account or their Medicare Summary Notices. If an unfamiliar brace or other piece of medical equipment appears, compare the claim with care you actually received and prescriptions or orders you recognize. Suspected Medicare fraud can be reported to the federal government rather than simply throwing away an unwanted piece of equipment. Families helping older relatives with bills may also want to review Medicare statements together, particularly if the beneficiary receives frequent unsolicited calls about braces, testing or medical supplies. The financial harm in schemes like this ultimately extends beyond an individual beneficiary: fraudulent claims drain money from a taxpayer-funded program intended to pay for legitimate health care.
Medicare Fraud Cases Continue to Be a Federal Priority
The Kessler and Gomez case was investigated by the FBI’s Miami Field Office and the Department of Health and Human Services Office of Inspector General. The Justice Department’s National Fraud Enforcement Division prosecuted the case through its Health Care Fraud Section. DOJ says its Health Care Fraud Strike Force Program currently includes nine strike forces operating in federal districts around the country. Since 2007, the program has charged more than 6,200 defendants who collectively billed federal health programs and private insurers more than $45 billion, according to the department.
For Medicare beneficiaries, however, the takeaway is much simpler: don’t provide Medicare information to an unexpected caller just because they promise equipment at little or no cost, and don’t ignore a medical supply or Medicare charge that you never requested.
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