跟进：法拉盛成人日托负责人认罪，1.27亿美元联邦医保与州医疗补助欺诈浮出水面

美国纽约州皇后县 Flushing 市57岁男子 Daniel Lee，本周一在联邦法院认罪，承认参与一项约1.27亿美元的联邦医保与纽约州医疗补助欺诈。司法部表示，Lee 认下医疗欺诈共谋与洗钱共谋两项罪名，定于2027年3月2日宣判，最高面临30年监禁，最终刑期由联邦地区法官在考虑量刑指南等因素后决定。

本站此前报道，纽约成人日托领域今年10月曾遭州与联邦联合执法，法拉盛与布鲁克林的多家机构在列，联邦医疗保险与医疗补助服务中心随后向纽约州发出合规警告。此次认罪把其中一家机构的具体手法摆上了法庭文件。

据法庭文件，Lee 是 Flushing 两家社会成人日托中心的主任，一家是 Happy Life Inc.，另一家是 Z&W Empire Enterprise, Inc.，对外以 Royal Adult Day Care Center 之名经营。约十年间，这两家机构向医疗补助受益人支付非法现金回扣与贿赂，引诱他们登记入托，并就从未提供的服务向医疗补助报账。有些报账对应的时段里，受益人正在住院，根本不可能接受日托服务。

同一时期，Lee 与同伙还在一家关联药房向联邦医保受益人与医疗补助受益人支付回扣与贿赂，该药房就无医疗必要性的处方药提交报账。执法人员搜查 Happy Life 时查获逾10万美元现金，并从银行账户中扣押约90万美元欺诈所得。

司法部国家欺诈执法司助理司法部长 Colin M. McDonald 表示，十多年来，Lee 参与运作的回扣安排以欺诈报账从联邦医保与州医疗补助中窃取资金。纽约东区联邦检察官 Joseph Nocella Jr. 表示，其办公室正着力查处社会成人日托欺诈，以保护公众福利项目。本案由卫生与公众服务部监察长办公室、联邦调查局 FBI、国税局刑事调查局 IRS-CI 等机构调查。（来源：美国司法部）

Follow-Up: Flushing Adult Day Care Director Pleads Guilty in $127M Medicare and Medicaid Fraud Scheme

Daniel Lee, 57, of Flushing, in Queens, New York, pleaded guilty on Monday in federal court to defrauding Medicare and New York State Medicaid of approximately $127 million. The Justice Department said Lee pleaded guilty to conspiracy to commit health care fraud and conspiracy to commit money laundering. He is scheduled to be sentenced on March 2, 2027, and faces a maximum penalty of 30 years in prison, with the sentence to be determined by a federal district court judge after considering the U.S. Sentencing Guidelines and other statutory factors.

GSM previously reported that New York's social adult day care sector faced a joint state and federal enforcement sweep in October, covering centers in Flushing and Brooklyn, followed by a compliance warning letter from the Centers for Medicare & Medicaid Services to New York State. This guilty plea puts the methods of one such operation into court documents.

According to court documents, Lee was a program director at two Flushing social adult day care centers, Happy Life Inc. and Z&W Empire Enterprise, Inc., doing business as Royal Adult Day Care Center. Over approximately ten years, the two centers paid illegal cash kickbacks and bribes to Medicaid recipients to induce them to enroll, and billed Medicaid for services that were never provided. Some claims were submitted for periods when the recipients were hospitalized and could not possibly have received the services.

During the same period, Lee and his co-conspirators paid kickbacks and bribes to Medicare beneficiaries and Medicaid recipients at a related pharmacy that submitted claims for medically unnecessary prescription drugs. When law enforcement executed a search warrant at Happy Life, they recovered over $100,000 in cash, and seized approximately $900,000 in fraud proceeds held in bank accounts.

Assistant Attorney General Colin M. McDonald of the Justice Department's National Fraud Enforcement Division said that for over a decade, Lee helped run a kickback scheme that stole from Medicare and Medicaid through fraudulent claims. U.S. Attorney Joseph Nocella Jr. for the Eastern District of New York said the plea marks the end of Lee's long-running fraud. The case is being investigated by HHS-OIG, the FBI, IRS Criminal Investigation, and OSC. (Source: U.S. Department of Justice)

来源：美国司法部

发布：GSM·美国（发布链接）

图片来源：图：美国卫生与公众服务部总部大楼（联邦固定图库）。 / Photo: U.S. Department of Health and Human Services headquarters building (federal asset library).

GSM Global · 本篇英文版 English edition of this story

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