The law firm of Broden & Mickelsen achieved another victory when they appealed a Medicaid / Medicare fraud case.
In this Medicaid / Medicare fraud case, United States v. Isiwele, Mr. Isiwele was convicted at trial of providing motorized wheelchairs to people who did not have a medical necessity for them. Mr. Isiwele retained the law firm of Broden & Mickelsen on appeal, and on March 7, 2011, the United States Court of Appeals for the Fifth Circuit remanded Mr. Isiwele’s case for resentencing.
According to court documents for case number 10-40347, “Defendant–Appellant Enitan Isiwele was convicted on multiple counts of health care fraud and conspiracy to pay kickbacks in connection with a scheme to fraudulently bill Medicare/Medicaid for power wheelchairs. In this appeal, Isiwele challenges the exclusion of certain prior inconsistent statements of witnesses at trial as well as various aspects of his sentence.”
The main issue at hand here during the appeal was the how the “loss amount” should be determined in Medicaid and Medicare fraud cases.
Should the loss amount be based on the amounts billed to Medicare/Medicaid or should the loss amounts be based on the “capped amounts” paid by Medicare/Medicaid?