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Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Posted  October 2, 2023

This week’s Scoundrel in the Spotlight is Jesus Virlar-Cadena, a former medical director of a Texas-based healthcare provider called Merida Group, who was recently sentenced to over four years in prison in connection with a fraudulent scheme involving over $150 million in false Medicare claims, according to a DOJ press release.

The Merida Group marketed hospice services to patients with long-term incurable diseases like Alzheimer’s and dementia, patients living at nursing homes, and others.  According to the DOJ, “[i]n some instances, Merida Group marketers falsely told patients they had less than six months to live,” and “sent chaplains to the patients based on the false pretense they were near death.”  The DOJ claimed that Mr. Virlar-Cadena “himself certified over $18 million in unnecessary hospice services as part of the over $150 million conspiracy.”  According to the DOJ, the Merida Group “made payment of their medical director fees contingent upon agreement to certify unqualified patients for hospice,” and that Mr. Virlar-Cadena “received luxury trips, bottle service at exclusive nightclubs, and other perks in exchange for his certification of unnecessary hospice patients.”

Another defendant involved in the scheme was previously sentenced to 20 years in prison, and another was sentenced to 15 years.

Falsely certifying unnecessary healthcare services for Medicare or Medicaid patients is unfortunately an all-too-common basis for healthcare fraud claims.  It can lead to unnecessary services being performed by healthcare providers, which not only harms the government and ultimately taxpayers by causing the unnecessary payment of government money, but it can also cause significant harm to the patients who receive unnecessary healthcare services.

If you would like information on what it means to be a whistleblower or think you may have information relating to healthcare fraud, or home health or hospice fraud in particular, please feel free to contact us so we can connect you with a member of the Constantine Cannon whistleblower lawyer team for a free and confidential consultation.

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Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Provider Fraud,