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US v. Mateos, No. 08-17178

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By FindLaw Staff on October 20, 2010 1:19 PM

Health Care Fraud Convictions Affirmed

In US v. Mateos, No. 08-17178, the court affirmed defendants' convictions and sentences for conspiracy to defraud the U.S., to cause the submission of false claims, and to pay health care kickbacks, and for conspiracy to commit health care fraud, holding that 1) it was not necessary for defendant to know all the details of how the fraud worked in order for her to be guilty of the conspiracy; 2) although the district court erred in excluding a potentially exculpatory videotape, the error was harmless; and 3) the district court did not abuse its discretion in concluding that the prejudicial impact of the evidence of defendant's marriage to a co-conspirator did not substantially outweigh its probative value.

 

As the court wrote:  "Dr. Ana Alvarez and Nurse Sandra Mateos were employees at St. Jude
Rehabilitation Center during its brief time as an operating clinic in 2003. St. Jude was ostensibly an HIV treatment center, but it was established as a front for a massive Medicare scam. The fraud involved falsely diagnosing patients with a condition that would justify treatments of WinRho, an expensive drug reimbursable by Medicare at a rate of about $4,900 per treatment to St. Jude. Because the treatment was medically unnecessary, employees at St. Jude would purchase only a small fraction of the drugs and drug treatments for which they
billed Medicare."

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