Überblick
International law firm McDermott Will & Emery secured a significant trial victory on behalf of Kenia Valle Boza, former director of HealthSun Health Plans Inc., whom the US Department of Justice (DOJ) alleged orchestrated a scheme to cause the coding of over $12 million in fraudulent diagnoses. Following a nine-day trial, a jury found Kenia not guilty of all charges, including one count of conspiracy to commit healthcare fraud and wire fraud and three counts of major fraud against the US; the court had granted the defense’s Rule 29 Motion as to two counts of wire fraud.
The trial team was led by McDermott partner Franklin Monsour Jr. and Adam Fels of Fridman, Fels & Soto, along with McDermott associate Kristin Schwam and law clerk Anna Silk.
This case represents one of the few criminal cases involving allegations of Medicare Advantage risk-adjustment upcoding. The DOJ had relied on two improper theories of prosecution: first, that Kenia knowingly recommended two diagnosis codes to coders and doctors based on an improper basis; and second, that she directed coders to use doctors’ electronic medical record login credentials to enter improper diagnosis information. Both theories were unsubstantiated at trial.
“We are pleased with the jury’s decision and proud to have represented Kenia, a longtime client, throughout this challenging process,” said partner Franklin Monsour Jr. “Our entire team worked tirelessly on this case. It took the jury only four hours to vindicate our client of these baseless charges, and to let her move on from this nightmare.”
This decision resolves U.S. v. Kenia Valle Boza (Case No. 1:23-cr-20417-KMW).
Über McDermott
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