What a $34.8M Medicare Fraud Case in South Florida Reveals About Federal Prosecutions
Two South Florida men have been sentenced to federal prison after admitting their roles in a health care fraud conspiracy that billed Medicare approximately $34.8 million for medically unnecessary orthotic braces. The $34.8M Medicare fraud case offers a recent look at how a complex healthcare billing investigation can develop into a federal criminal prosecution.
The case involved seven Florida durable medical equipment companies, allegedly fraudulent doctors’ orders, illegal kickbacks, and a strategy of moving billing among different companies when Medicare payment suspensions became a problem.
But beyond the multimillion-dollar figure, the case provides a useful look at something that often happens long before a federal fraud prosecution reaches sentencing:
Investigators build these cases by connecting billing data, business relationships, medical documentation, financial transactions, and evidence of intent.
For healthcare providers and business owners in South Florida, understanding that process can be just as important as understanding the criminal charge itself.
What Happened in the $34.8M Medicare Fraud Case?
According to the U.S. Attorney’s Office for the Southern District of Florida, Kenneth Charles Kessler III, 43, of Miami, and Michael Andrew Gomez, 43, of Miramar, owned and operated seven durable medical equipment (DME) supply companies in Florida.
Federal prosecutors said those companies submitted millions of dollars in claims to Medicare for orthotic braces that beneficiaries did not need.
According to court documents described by the Department of Justice, the scheme also involved paying illegal kickbacks and bribes to obtain fraudulent signed doctors’ orders.
Those orders were then used to ship braces to Medicare beneficiaries around the country, including people who had neither requested nor needed them.
The government also alleged that the defendants shifted billing between their different DME companies to evade Medicare payment suspensions.
Kessler was sentenced to 33 months in federal prison, while Gomez received 24 months. Both had pleaded guilty in May 2026 to one count of conspiracy to commit health care fraud.
The FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG) investigated the case.
The $34.8 Million Figure Is Only Part of the Story
Large dollar amounts naturally attract attention.
But the amount billed to Medicare is not the only important feature of a federal healthcare fraud investigation.
Investigators may examine how claims were generated, who authorized them, whether the underlying services or equipment were medically necessary, where patient information originated, how businesses were connected, and where the money ultimately went.
In this case, prosecutors pointed to several interconnected allegations:
- Medically unnecessary equipment
- Fraudulent doctors’ orders
- Kickbacks and bribes
- Multiple DME companies
- Medicare billing
- Attempts to avoid payment suspensions
Viewed individually, records from different companies or transactions may tell only part of the story.
Federal investigators can attempt to assemble those pieces into evidence of a broader scheme.
That distinction becomes particularly important when prosecutors must establish criminal intent rather than simply inaccurate billing.
A Billing Problem Is Not Automatically Medicare Fraud
The distinction between an error and intentional fraud matters.
Healthcare billing systems can be complicated. Incorrect coding, documentation problems, administrative mistakes, or disagreements over medical necessity do not automatically establish that someone knowingly participated in a criminal scheme.
Federal prosecutors still have to prove the elements of the offense charged.
The more difficult questions frequently concern what a person knew, what they intended, and how their actions relate to the conduct alleged by prosecutors.
For example, investigators might examine whether billing irregularities occurred repeatedly, whether internal records contradict submitted claims, whether payments were tied to referrals, or whether communications show knowledge of an alleged scheme.
Healthcare providers concerned about this distinction can read our more detailed guide to Medicare billing errors and when they can become criminal issues in Miami.
Why Conspiracy Changes the Scope of a Federal Fraud Case
Another important detail in the South Florida case is the charge itself.
Kessler and Gomez each pleaded guilty to conspiracy to commit health care fraud.
Conspiracy cases can extend beyond the question of who personally submitted a particular claim.
Federal prosecutors may instead examine relationships between business owners, employees, marketers, healthcare professionals, suppliers, and others whom they believe participated in a common unlawful plan.
That can make communications, financial transfers, corporate records and relationships between participants especially important.
It also does not mean that everyone associated with a business or with someone accused of fraud automatically participated in a conspiracy.
The government still has to establish the required connection between the individual defendant and the alleged criminal agreement.
Our guide to federal conspiracy charges and what prosecutors must prove explains those principles in greater detail.
Federal Investigators Can Follow the Business, Not Just the Claim
The allegation that billing moved among several DME companies after payment suspensions illustrates another feature of complex fraud investigations.
Investigators may look beyond individual Medicare claims and reconstruct the broader business structure surrounding them.
That can include:
- Corporate ownership records
- Bank accounts and transfers
- Medicare billing histories
- Emails and text messages
- Contracts and invoices
- Referral arrangements
- Patient records
- Physician orders
- Payments to marketers or other businesses
- Relationships between affiliated companies
This means a healthcare fraud investigation can become a financial and digital investigation at the same time.
Records that appear unrelated when reviewed separately may be compared across businesses, accounts and individuals.
South Florida Remains a Major Focus of Federal Healthcare Fraud Enforcement
The September sentencing also comes during a broader period of federal healthcare fraud enforcement.
In June 2026, the Department of Justice announced its National Health Care Fraud Takedown involving 455 defendants nationwide and more than $6.5 billion in alleged fraud.
In the Southern District of Florida, federal prosecutors announced charges against 12 defendants in cases involving more than $4 billion in allegedly fraudulent claims connected to DME, skin substitutes and wound care products, laboratory testing, and community mental health services.
Those defendants are accused and are presumed innocent unless proven guilty.
The September $34.8 million case is separate, but together these developments demonstrate the level of investigative resources currently being directed toward federal healthcare fraud.
What Can Trigger Scrutiny in a Medicare Fraud Investigation?
There is no single fact that automatically means criminal charges will follow.
Depending on the circumstances, however, investigators may focus on patterns such as unusual billing volumes, questionable medical necessity, patient complaints, referral payments, inconsistent documentation, suspicious ownership structures, or relationships among providers, suppliers and marketers.
Government agencies can also compare large quantities of claims data.
That means an investigation may begin before the healthcare provider or business owner realizes that federal authorities are reviewing the activity.
Sometimes the first obvious indication is not an arrest.
It may be a subpoena, a request for records, contact from federal agents, a search warrant, a Medicare payment suspension, or another investigative action.
What If Federal Agents Contact You About Healthcare Billing?
Being contacted by investigators does not itself establish criminal liability.
It can, however, indicate that the government is collecting information about a person, company or broader network.
One of the first questions is often how investigators currently view the person they are contacting.
Someone may be treated as a witness, a subject whose conduct falls within the scope of an investigation, or potentially a target whom prosecutors believe may have committed an offense.
Those distinctions can change as investigators gather additional evidence.
A person facing that situation should also avoid destroying, altering or concealing records. The appropriate response depends heavily on the circumstances and on the nature of the government inquiry.
Dustin Tischler Law represents individuals, healthcare professionals and business owners facing white collar and fraud investigations in Miami and South Florida, including complex federal matters involving healthcare fraud and financial records.
Why This South Florida Case Matters
The $34.8 million headline is striking.
The more useful lesson, however, is found in how prosecutors described the alleged scheme.
The case connected medical equipment, doctors’ orders, Medicare claims, kickbacks, multiple companies and attempts to continue billing despite payment suspensions.
That illustrates why federal healthcare fraud cases rarely turn on a single document.
They can involve years of billing data, financial records, communications and testimony that investigators attempt to assemble into evidence of intentional fraud.
For healthcare providers and business owners, that distinction matters.
A billing discrepancy and a criminal fraud scheme are not the same thing. Determining where prosecutors believe that line has been crossed often becomes one of the central issues in a federal healthcare fraud investigation.
Sources
- U.S. Attorney’s Office, Southern District of Florida — South Florida Men Sentenced to Prison for $34.8M Health Care Fraud Scheme Targeting Medicare Beneficiaries, September 4, 2026.
- U.S. Department of Justice — National Health Care Fraud Takedown Results in 455 Defendants Charged in Connection with Over $6.5 Billion in Alleged Fraud, June 25, 2026.
Facing a Federal Fraud Investigation in Miami?
If you have received a subpoena, been contacted by federal agents, learned that your business records are being reviewed, or are facing allegations involving Medicare or healthcare billing, understanding the scope of the investigation early can be important.
The Law Office of Dustin Tischler, P.A. represents clients facing serious federal and white collar criminal matters in Miami and throughout South Florida.
Contact Dustin Tischler Law to discuss your situation.
This article discusses publicly reported court proceedings and government allegations for general informational purposes. Every criminal case depends on its specific facts and evidence.
