Categories: Anti-Kickback & Fraud, Health Law, Stark,

A Judge in Miami has sentenced two former officers of a Miami based mental health therapy company to 50 ane 35 years in prison; making the sentences two of the largest ever for Medicare Fraud. The sentences reflect a trend of increasingly strong punishment for Medicare Fraud; however it also may reflect how treacherous guilty pleas can be in federal court.

In this case, the two defendants pled guilty without a trial and without a plea agreement with the government.  In federal criminal prosecutions, defendants who plead guilty generally do so through plea agreements with prosecutors.  However, there are occasions where such an agreement waives appeal rights or commits a defendant to agree to facts they may not be comfortable with, including in many cases, the level of involvement in the crime or the amount of money at issue.

Why those things can be very significant is that judges are guided in sentencing defendants by the Federal Sentencing Guidelines.  The Guidelines provide what is essentially a score sheet for various offenses with adjustments based on various criteria, including the role in the crime and the “amount of loss” incurred in a scheme.  In many instances, the number of crimes a defendant pleads guilty to is not as important as the type of crime and the amount of loss or other adjustment.

However, regardless of the terms of the plea agreement and the Guidelines, federal judges can sentence defendants who plead guilty to any sentence authorized under the law.  Judges are authorized to sentence defendants to the maximum amount of time under the law for all of the crimes added together; which can add up with 10 or 20 years per crime.  A defendant pleading guilty is taking on faith that the judge will honor the Guidelines or the plea agreement. In most instances, judges do.

In this case, it appears that the attorneys for the defendants felt they could not agree with the terms of the proposed plea agreement. Either the amount at issue or some other component of the plea agreement.  Believing they stood a better chance with the court in arguing these issues, the defendants plead guilty without a plea agreement. It appears the judge was unconvinced, and without any agreement to even consider, sentenced the defendants to an extremely large sentence.