Miramar man sentenced in major Medicare fraud targeting seniors
A federal judge has sentenced a Miramar resident to prison after finding him complicit in a multimillion-dollar scheme that billed Medicare for medically unnecessary orthotic braces, according to the U.S. Attorney’s Office for the Southern District of Florida.
Michael Gomez, 43, of Miramar, was sentenced to two years in federal prison after pleading guilty in May to conspiracy to commit health care fraud. His co-defendant, Kenneth Kessler of Miami, received a 33-month prison term.
“Through these DME companies, they submitted millions of dollars in false claims to Medicare for medically unnecessary orthotic braces,” authorities wrote in a news release.
Prosecutors say Gomez and Kessler operated several durable medical equipment (DME) companies that submitted claims that ultimately billed Medicare for $34.8 million, according to the indictment. The charges allege the defendants used the DME businesses to obtain fraudulent doctor’s orders and ship orthotic braces to Medicare beneficiaries who did not request or need them.
How the scheme worked, according to authorities
- Defendants used DME companies to generate and submit false claims to Medicare for orthotic braces.
- Fraudulent or improperly obtained doctor’s orders were used to support the claims.
- Braces were shipped to beneficiaries who neither requested nor needed them and Medicare reimbursed the suppliers.
- Funds were used to pay bribes and to compensate marketing companies that helped acquire beneficiaries’ personal information through aggressive telemarketing.
The indictment describes a broader operation involving co-conspirators and marketing firms that were paid to target Medicare beneficiaries. Prosecutors say those marketing campaigns used deceptive and aggressive telemarketing tactics to obtain private information from seniors, which was then used to create false billing records.
Local and practical implications
Medicare eligibility generally begins at age 65. To be covered, medical equipment must be ordered by a licensed physician or other qualified health provider and deemed medically necessary. The scheme alleged in federal court highlights how some suppliers and middlemen exploit vulnerabilities in the system and in the outreach to beneficiaries.
For Miramar residents — particularly seniors and caregivers — the case is a reminder to be cautious about unsolicited calls offering medical equipment. Medicare beneficiaries who receive unexpected equipment, bills, or calls asking for personal or medical information should:
- Refuse to give personal identifying or medical information over the phone to unknown callers.
- Contact their physician directly before accepting or paying for medical equipment.
- Report suspicious calls, mailings or equipment deliveries to Medicare at 1-800-MEDICARE and to local law enforcement.
| Defendant | Age | Sentence | Alleged billed amount |
|---|---|---|---|
| Michael Gomez | 43 | 2 years | $34.8 million (total billed to Medicare) |
| Kenneth Kessler | — | 33 months |
Officials say the alleged fraud included paying bribes for the illegal documentation needed to substantiate the false claims. The payments also extended to marketing companies tasked with procuring beneficiary information. Those marketing firms, prosecutors allege, were paid to run campaigns that pressured or deceived seniors into providing private details.
The case was prosecuted by the U.S. Attorney’s Office for the Southern District of Florida. Sentences for health care fraud can include prison time, restitution and fines; the details of any restitution ordered were not provided in the initial news release.
As federal authorities continue to pursue cases that exploit Medicare, local law enforcement and community groups in Miramar may increase outreach to seniors to raise awareness about telemarketing scams and the proper procedures for obtaining medical equipment under Medicare.
Residents with concerns about potential fraud or who have received unexpected equipment should document delivery dates and communications and contact Medicare and local authorities for guidance.
