Health Care Fraud Blog

Since the inception of Medicare Fraud Strike Force (MFSF) operations in 2007, federal prosecutors in Washington, D.C., have indicted 104 cases with 184 defendants in Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

The MFSF is a multi-agency team of federal, state and local prosecutors and agents designed specifically to combat Medicare fraud. Strike force operations began in the Miami area on March 1, 2007.

The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the local office of U.S. Attorney. Each team has four to six agents, at least one agent from the FBI and HHS Office of Inspector General, as well as representatives of local law enforcement. The Florida MFSF teams operate out of the federal Health Care Fraud Facility in Miramar, Fla. Kirk Ogrosky is Deputy Chief of the U.S. Department of Justice Criminal Division’s Fraud Section

The Medicare Fraud Strike Force was conceived and implemented by the Section to combat Medicare fraud through aggressive use of “real time” law enforcement techniques. Between March and September 2007, MFSF prosecutors charged 117 individuals in 74 cases, including company owners, pharmacists, physicians and corrupt patients, and convicted 61.

Sentences imposed in Strike Force cases averaged nearly five years, including one of 151 months, and included payment of millions of dollars in restitution.

MIAMI, FL (September 18, 2008) - Thomas McKenzie, 53, a Miami physician’s assistant pleaded guilty today to defrauding the Medicare program in connection with a $119 million HIV infusion fraud scheme.

McKenzie, pleaded guilty in Miami to one count of conspiracy to commit healthcare fraud and one count of submitting false claims to the United States. McKenzie admitted that beginning in approximately December 2001 and continuing through approximately April 2004, he trained physicians at 11 Miami medical clinics how to make medical records appear to support medically unnecessary HIV infusion services allegedly administered to patients. McKenzie also admitted to overseeing the documentation of fraudulent services at these clinics to make it appear that legitimate services were being provided at those facilities.

According to information contained in plea documents, McKenzie entered into an agreement with brothers Carlos, Luis and Jose Benitez to assist them in operating a series of fraudulent HIV infusion clinics throughout south Florida. The Benitez brothers allegedly referred HIV-positive Medicare beneficiaries to these clinics and directed clinic staff to pay cash kickbacks to the patients. McKenzie admitted that his role at the Benitez-owned clinics was to train and oversee the physicians working there, ensuring that the medical records appeared to support the expensive HIV infusion treatments being billed to Medicare by the clinics.

Miami Herald investigative reporter Jay Weaver wrote a series of articles last month disclosing the intricacies often associated with Medicare fraud / money laundering conspiracies. Those articles are quite revealing and detail these types of criminal operations. To read those articles and to learn more about the Benitez brothers click here.

McKenzie admitted to knowing that the infusion treatments being billed at the clinics were medically unnecessary and/or never provided. In his plea, McKenzie admitted that the HIV infusion clinics where he worked submitted $119 million in fraudulent claims to Medicare for medically unnecessary HIV infusion therapy.

According to a report by the Inspector General for the U.S. Department of Health and Human Services made public a year ago, for which attorney, Benson Weintraub, a frequent contributor to this blog was interviewed by the Washington Times (click here to read that blog post), health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.

Continue reading "PHYSICIAN’S ASSISTANT PLEADS GUILTY TO ROLE IN $119 MILLION FRAUDULENT HIV INFUSION SCHEME" »

FORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month.

The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.

Continue reading "Healthcare Fraud Blog Publisher to Attend AHLA/HCCA Fraud and Compliance Forum" »

By
Benson Weintraub, Esq.

FORT LAUDERDALE, FL (September 15, 2008) In post-Depression era history, the federal government has yielded to systemic extensions of credit through extortionate means, most recently in bailing out Fannie and Freddie, the first of many economic casualties of the sub-prime mortgage crisis.

The impact upon markets and investors associated with the failure of Enron and WorldCom resulted in an expression of American political condemnation culminating in Sarbanes-Oxley and the new corporate controls, including radical expansion of corporate compliance programs.

The anecdotal reduction of securities fraud correlated with compliance programs over the past fifteen years—and amendments to the federal Corporate Sentencing Guidelines—should have significantly deterred offenders having prompted Sarbanes-Oxley, including Enron, WorldCom, Adelphia. Still, in it’s wake, massive white collar frauds are perpetrated in the health care industry, accounting profession, and financial markets.

The unanticipated failure of the loans endorsed by Fannie and Freddie Mac triggered the latest institutional scam; this time under the nose of regulators, compliance officers, audit committees, oversight committees; and which brings the imprimatur of government to the equation by it’s guaranty on the defaulted mortgages, past, present, and future.

The market has always been inundated with ordinary financial scams perpetrated by individuals by deceiving investors with respect to “prime bank instruments” supported by “letters of credit” from the “banks.”. United States v. Polichemi, 219 F.3d 698 (7th Cir. 2000)(defendants convicted of money laundering). The provisional success of this conspiracy was facilitated by a minor official’s regulatory assistance, conduct which was also criminalized.

Yet when more conventional looking institutional investors driven by the same motives invent a similar instrument labeled “sub prime mortgages”—and get the imprimatur of the government through its support, not previous ownership—the offenders not only get a free ride but the domino effect on the lack of confidence in the markets mitigate institutional losses for utilitarian, not moral reasons.

The sub-prime mortgage” scam, reminiscent of the 1980’s bailout of the Savings and Loan Industry, then Bear Stearns which begets the fall of Lehman Brothers, now seeking protection and reorganization of investment in US Bankruptcy Court. Confidence on Wall Street has never been lower with the impending takeover of Merrill Lynch by Bank of America.

As business continues as usual, well, where were the compliance officers?

MIAMI, FL (September 11, 2008) - Miami physicians, Carlos Contreras, M.D., and Ramon Pichardo, M.D., each pleaded guilty today to defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme. To read the indictment in its entirety, click here.

Contreras, 60, pleaded guilty to conspiracy to commit healthcare fraud and admitted that he owned a Miami clinic named CNC Medical Inc. (CNC), which purported to specialize in the treatment of HIV positive patients. From November 2002 through April 2004, Contreras admitted that he conspired with others to submit approximately $6.8 million in fraudulent Medicare bills; that he knowingly signed documents containing false information about treatments purportedly given to HIV positive patients. Contreras admitted that he approved medically unnecessary treatments at CNC and that CNC received approximately $4.2 million from the Medicare program as a result of his and his co-conspirators’ criminal conduct.

Furthermore, Contreras admitted that he entered into an agreement in approximately November 2002 with Carlos Benitez, Luis Benitez, Thomas McKenzie, Pichardo and others to operate CNC as a fraudulent HIV infusion clinic.

According to a report by the Inspector General for the U.S. Department of Health and Human Services made public a year ago, for which attorney, Benson Weintraub, a frequent contributor to this blog was interviewed by the Washington Times (click here to read that blog post), health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.

Miami Herald investigative reporter Jay Weaver wrote a series of articles last month disclosing the intricacies often associated with Medicare fraud / money laundering conspiracies. Those articles are quite revealing and detail the underworld character of these types of criminal operations. To read those articles click here.

Continue reading "Miami Physicians Plead Guilty and Admit Ordering $6.8M Worth of Unnecessary HIV Infusion Treatments" »

MIAMI, FL (September 9, 2008) – Dilcia Marinez, 57, pleaded guilty today in U.S. District Court to her role in defrauding the Medicare program and laundering the proceeds of the crimes in connection with a $14 million HIV infusion fraud scheme. Click here to read the indictment.

According to information in plea documents, the Benitezes referred HIV-positive Medicare beneficiaries to the clinic and directed McKenzie to teach doctors how to make it appear legitimate health services were being provided.

For the past couple of months, Miami Herald reporter Jay Weaver has written a number of articles detailing how South Florida remains a hotbed for Medicare fraud, including several articles about the Benitez brothers' fraudulent HIV infusion schemes. To read those articles, click here.

Marinez pleaded guilty to conspiracy to commit health care fraud and conspiracy to commit money laundering. Marinez admitted that she was the president and director of G&S Medical Center Inc. (G&S), a Miami health care clinic. Marinez admitted that she entered into an agreement in approximately May 2003 with Carlos Benitez, Luis Benitez, Thomas McKenzie and others to operate G&S as an HIV infusion clinic. According to a report released almost one year ago, by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.

Continue reading "Miami Still a Hotbed for Medicare Fraud - HIV Clinic Administrator Pleads Guilty for Role in a $14 Million Medicare Fraud Scheme" »