BROADCASTS.com

b'

Fraudster Must Serve Time and Lose His Residence to Pay Restitution\\n\\nPost 4698\\n\\nArmando Valdes appealed his 60-month sentence for health care fraud \\nafter he pleaded guilty. Valdes\'s conviction and sentence arose out of \\nhis scheme to submit millions of dollars in fraudulent medical claims to\\n United Healthcare and Blue Cross Blue Shield for intravenous infusions \\nof Infliximab, an expensive immunosuppressive drug. These infusions, \\npurportedly given to patients at Valdes\'s medical clinic, Gasiel Medical\\n Services ("Gasiel"), were either not provided or were medically \\nunnecessary.\\n\\nIn United States Of America v. Armando Valdes, No. 22-12837, United \\nStates Court of Appeals, Eleventh Circuit (December 19, 2023) the \\nEleventh Circuit disposed of the arguments asserted by Valdes.\\n\\nLOSS AMOUNT\\n\\nFederal Courts sentence convicted defendants based upon offense levels \\nset by federal statutes. The sentences are increased with the amount of \\n"loss" caused by the offense. In Valdes\'s case, his base offense level \\nwas increased by 22 levels because the district court found that the \\nloss amount was $38 million, and thus more than $25 million.\\n\\nSection 2B1.1(b)(1)(L) provides that a defendant\'s base offense level is\\n increased by 22 levels if the loss from the fraud offense was more than\\n $25 million but less than $65 million.\\xa0 Intended loss includes harm \\n"that would have been impossible or unlikely to occur."\\n\\nANALYSIS\\n\\nValdes did not show the Eleventh Circuit that the district court\'s loss \\namount of $38 million was clearly erroroneous. Valdes admitted that \\nthrough Gasiel, he submitted approximately $33 million in fraudulent \\nclaims to United Healthcare and approximately $5 million in fraudulent \\nclaims to Blue Cross Blue Shield.\\n\\nEven if United Healthcare was unlikely to reimburse Valdes for the \\nentire amount billed or for duplicate claims those claims were \\nnonetheless properly included in the intended loss amount. At the \\nsentencing hearing, Valdes\'s own fraud analyst testified that, even \\naccounting for duplicate claims, the total loss amount was above $25 \\nmillion, the threshold for the 22-level increase in Valdes\'s offense \\nlevel.\\n\\n\\nGo to the Insurance Claims Library \\u2013 \\nhttp://zalma.com/blog/insurance-claims-library.