May 7, 2008

Miami Pharmacy Owner of Convicted of Medicare Fraud, Co-defendant Acquitted

After a six day trial in Miami, a federal jury in Miami convicted Gustavo Smith, 43, the owner of a Miami pharmacy for his role in a $3 million Medicare fraud scheme and for money laundering of all 17 counts charged against him in the September 2007 Indictment.

The charges included: conspiracy to defraud the U.S. government, to commit health care fraud, and to submit false claims to the Medicare program; seven counts of health care fraud; seven counts of submitting false claims to the Medicare program; conspiracy to commit money laundering; and one count of money laundering.

Schock%20verdict-1.jpgSmith’s co-defendant, Friedhelm Schock, the nominee owner of Medstar, was acquitted by the jury on all charged counts.

According to Schock's defense attorney, Michael Band of Adorno & Yoss, the government argued that Schock was the "nominee" owner of the pharmacy, signed all the Medicare documents, opened all the bank accounts, formed the corporation, received monies far in excess of what reflected the work he performed at the pharmacy and lied to the government to cover up the fraud.

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April 17, 2008

Psychiatrist Sentenced to 30 Months for Medicare Fraud

ist1_5514174_dictionary_series_psychology_psychiatry.jpgCheck this out. Usually you would think of a psychiatrist as being someone who treats patients who suffer from auditory or visual hallucinations. However, an Illinois psychiatrist is headed to federal prison for two and a half years for defrauding Medicare of $1.75 million for submitting bills to Medicare for patients he never saw.

According to the indictment, Dr. Ajit Trikha (ah-JEET' TREEK'-ah) a 55-year-old psychiatrist pleaded guilty last June in U.S. District Court in East St. Louis to two counts of health care fraud. Trikha submitted bills to Medicare for reimbursement claiming that he had therapy sessions with patients, when in truth he never met the patient and in some instances was out of the country on vacation. He also billed for group-therapy sessions that far exceeded the 12-person limit set by Medicare and Medicaid.

Additionally, the indictment specifically alleged that the doctor and his medical practice "regularly submitted claims with [erroneous] . . . codes when spending little or no time with the patient rather than approximately 20 to 30 minutes face-to-face with the patient as required by 08 17, or approximately 45 to 50 minutes face-to-face with the patient as required by 9081. TRIKHA and TRX also submitted claims with these codes for visits with patients who were not able to communicate verbally at all."

A federal judge has ordered Trikha to reimburse the government for the money he bilked.

April 11, 2008

Miami Woman Sentenced to 10-years for Role in $170M Healthcare Fraud Consiracy

540236_secret_garden.jpgOn April 2, the same day that seven co-defendants were indicted (click here) for their roles in an $11 million Medicare fraud scheme involving HIV infusion clinics, Rita Campos Ramirez who had pleaded guilty in August 2007 to a $170 million conspiracy to commit health care fraud was sentenced to 10 years in prison. According to the U.S. Department of Justice and local federal prosecutors, the scheme represents the largest known individual case of Medicare fraud in the history of the program.

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April 8, 2008

Feds Charge Seven in $11 Million Medicare Fraud Scheme

253396_iv_drip_-_intravenous_treatmen.jpgSeven Miami-area residents were indicted on April 2, 2008, in connection with an $11 million Medicare fraud scheme involving HIV infusion clinics. The defendants were all charged with: conspiracy to defraud the United States, to cause the submission of false claims, to pay health care kickbacks, and conspiracy to commit health care fraud.

According to a report filed early last fall, 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.

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April 4, 2008

Two Florida Men Sentenced for Healthcare Fraud & Money Laundering

moneylaundering.jpg.gif On April 2, 2008, U.S. District Court Judge Adalberto Jordan of the Southern District of Florida sentenced defendant Michael Labrada, 27, of Miami to a 97 month prison term and Miguel Castillo, 42, of Miami, to a 57 month prison term for their participation in a multi-million dollar health care fraud and money laundering scheme.

Labrada was convicted of conspiring with Angel Castillo, Jr. to commit health care fraud by serving as a straw owner of a medical equipment company known as JJ & D Medical Equipment, Inc. The company submitted more than $6.8 million dollars in bogus claims and received approximately $1.6 million in payments. In the second case, Labrada was convicted of money laundering charges in connection with a $2.3 million laundering scheme orchestrated by his co-defendant, Angel Castillo, Jr.

Miguel Castillo was also convicted of related health care fraud and money laundering conspiracy charges. In addition to serving as a straw owner of a medical equipment company, Miguel Castillo collected hundreds of thousands of dollars in fraud proceeds from check cashers at the direction of his cousin and co-conspirator, Angel Castillo, Jr.

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March 11, 2008

Defendant Acquitted of Healthcare Fraud

Guerrero%20verdict.jpg Yeleiny Guerrero was the co-owner of Denis Medical Services, Inc. She was charged in a 6 count indictment with conspiracy to defraud the United States by causing the filing of false Medicare claims, conspiracy to commit health care fraud and 4 counts of health care fraud. Her codefendants were Ramon Oscar Soto, Araelia Nieto and Rafael Moreno. Soto was the leader of the charged conspiracy which involved three separate DME companies: P & A Medical, ROS Medical and Denis Medical Services. Nieto and Moreno were co-owners of the other two DME companies. All three of them pleaded guilty and were sentenced to time in the federal pokey: Moreno 18 months, Nieto 24 months and Soto 37 months.

The evidence at trial demonstrated that Guerrero established the corporation in her name, opened a bank account as the sole signatory, applied for all state and federal licenses and signed the Medicare Supplier Application so as to obtain a provider number. She worked at the office in a warehouse district daily from 8 am to 12 noon.

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December 15, 2007

Medicare Fraud Strike Force Cases Result in Long Prison Terms for Five Health Care Company Owners

On December 13, 2007, the owners of five separate Miami-based health care corporations have were sentenced to prison. Collectively, the five defendants filed fraudulent claims with Medicare for over $28.6 million worth of unnecessary durable medical equipment (DME) and infusion therapy.

The five defendants who were sentenced in Miami are: Rodolfo Aenlle, 47, who was sentenced to 84 months in prison; Simon Seruya, 74, who was sentenced to 50 months; Alberto Gourie, 35, who was sentenced to 51 months in prison; William Garcia, 31, who was sentenced to 41 months; and Marina Ruiz, 48, who was sentenced to 24 months in prison. In total, these individuals were ordered to repay more than $13 million in restitution.

“We are continuing to seek appropriate sentences for the most serious Medicare fraud offenders,” said Assistant Attorney General Fisher. “The Strike Force in South Florida has successfully prosecuted some of the most egregious cases of Medicare fraud, and the average prison sentence for these violators is now up to almost 52 months which is above the national average of 31 months, with many Strike Force defendants receiving over 10 years.”

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September 21, 2007

South Florida bills billions for HIV

September 21, 2007

From The Washington Times

By Jim McElhatton - Doctors and clinics in three Southern Florida counties account for most of the cash.jpg billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.

Federal health care regulators call the lopsided billing patterns "egregious" and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.

"It"s all ultimately part of the money-driven, underground economy in Miami," said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.

According to a report this week 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.

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September 16, 2007

Miami Defendants Sentenced on Health Care Fraud

On August 31, 2007, defendants Maricel Li and Marta Perez, both residents of Miami, were sentenced by United States District Court Judge James I. Cohn in Fort Lauderdale, Florida.

moneylaundering.jpg.gif Li was sentenced to twenty-four (24) months' imprisonment, followed by three (3) years of supervised release. Li was also ordered to pay $556,519.85 in restitution. Perez was sentenced to five (5) months' imprisonment, to be followed by two (2) years of supervised release.

Both defendants had previously pled guilty. Defendant Li had pled guilty to an Information charging her with conspiracy to 367942_paper_trail.jpg.gifcommit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.

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September 7, 2007

Fed's Charge Texas Man with Medicare Fraud in Patient Transport Scam

On August 28, 2007, a federal grand jury indicted the former operations director of A-Care EMS Inc. on charges that he sent fraudulent claims to the Centers for Medicare and Medicaid Services to pull in more money.

The indictment, filed Tuesday in the U.S. District Court for the Southern District of Texas, claims Rodney Lee Ramos, 34, of Weslaco, instructed emergency medical technicians to transport patients for dialysis who were not confined to bed."

ambulance.jpgAccording to the indictment, Ramos worked as an EMT coordinator for A-Stat Ambulance Services Inc., which was owned by Guadalupe Garces Jr. and Araceli Garces. Medicaid and Medicare placed a vendor hold on that ambulance provider -- withholding payment to the company -- after federal agents determined that the owners were defrauding the federal and state health insurance programs.

September 7, 2007

Florida Durable Medical Equipment Owner Convicted of Medicare Fraud

On August 30, 2007, the owner and operator of a Miami durable medical equipment company and an assisted living facility was convicted as charged in a five-count indictment by a federal jury in Miami of Medicare fraud in U.S. District Court for the Southern District of Florida. US%20District%20court%20miami%20pic.jpg

After a jury trial at federal court in Miami, the jury found Marianela Smith guilty on all charged counts including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit health care fraud; and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.

Smith faces a maximum sentence of 30 years in prison. Prior to sentencing the U.S. Probation Office will complete a pre-sentence investigation and submit a Pre-Sentence Report to the judge for consideration. The PSI will contain an advisory guideline sentence which the court must consider in determining what type and length of sentence is sufficient, but not greater than necessary, to comply with the statutory directives set forth in 18 U.S.C. § 3553(a).

Smith is scheduled to be sentenced November 9, 2007, before U.S. District Court Judge Joan A. Lenard.

May 25, 2007

Medicare Fraud Defendant Gets 10-Year Prison Term

On May 18, 2007, the US Attorney's Office reported that Jafet Garcia, a defendant in a massive South Florida Medicare fraud scheme, was sentenced in West Palm Beach Federal court to ten (10) years’ imprisonment.

According to the court file, the defendant and his partners purchased four medical equipment companies located in Miami-Dade and Palm Beach Counties, between February 2004 and December 2004. The defendant and his partners recruited individuals to pose as the owners of these companies. After setting up the companies, the defendant and his partners obtained patient and physician information which they used to prepare bogus prescriptions and/or certificates of medical necessity. The bogus prescriptions and certificates purported to authorize the provision of various types of medical equipment for the named Medicare beneficiaries; in truth, the prescriptions and certificates were prepared by the defendant and/or his accomplices and contained forged physicians’ signatures.

The defendant and/or his partners provided the bogus prescriptions and certificates to a Miami billing company for submission to Medicare. The billing company prepared Medicare claims which sought reimbursement for the cost of the equipment listed in the bogus prescriptions and certificates, even though such equipment was never authorized by a physician or provided to the beneficiaries. Medicare processed the fraudulent claims and issued reimbursement checks which the defendant and/or his accomplices cashed at a Miami check cashing store. The defendant and his partners would submit claims through a particular medical equipment company for only two to three months, close it and then begin billing through another company to avoid getting caught.

The four companies used by the defendant and his partners to defraud Medicare were Sunset Medical Corporation, King Medical Service and Supplies Corporation, Travelango Services Corp. and Clear Choice Home Health, Inc. During the course of the scheme, the defendant and his partners submitted more than $9 million in bogus Medicare claims.

May 24, 2007

11th Circuit Reverses Healthcare Fraud, Money Laundering Convictions

On May 11, the US 11th Circuit Court of Appeals, issued an opinion reversing the of convictions, all convictions of one defendant for Medicare Health Care Fraud and money laundering, and vacated the sentence for incorrect loss calculations.

The scheme involved transporting patients to the defendants’ pharmacies in exchange for illegal kickbacks for patients and doctors. However, no evidence indicated that Medicare was billed for unnecessary medical procedures. A confidential informant met with the defendants to exchange, for a fee, their checks for cash, admitted on cross-examination that one defendant, Medina, a secretary, was always sent out of the room to avoid her hearing them talk about the kickback scheme.

The Court also vacated the money laundering counts which related to the fraud counts it had set aside, since money laundering involves the proceeds of activity known by the defendants to be illegal.

The Court upheld the convictions of two defendants as to the general conspiracy charge, under 18 U.S.C. § 371, but vacated the secretary’s conviction, finding that her lack of awareness of the kickback conspiracy, and of the conspiracy’s other objectives, left insufficient evidence to
convict.

The Court remanded the case for resentencing and noted that the district court failed to make a sufficient loss calculation, and instead sentenced the defendants for the entire amount Medicare was billed in the period, without explanation. However, in the absence of evidence of Medicare’s payment of unnecessary medical claims, or that the patient kickback scheme resulted in any actual loss to Medicare, this calculation was inadequate.

May 10, 2007

Fed Fraud Strike Force Arrests 38 in South Florida Medicare Scam

On May 9, investigators said the arrests of 38 people are the result of an operation conducted by a strike force made up of a team of federal, state and local investigators who have been concentrating on Medicare fraud -- ''especially prevalent'' in South Florida -- since early March.

According to remarks made by Attorney General Alberto R. Gonzales at a press conference with Michael Leavitt, Secretary of Health and Human Services, "the indictments outline various types of fraudulent schemes. Those schemes included compounded aerosol medications -- a process where a pharmacist makes medicine to meet a special medical need for a patient, rather than dispensing less expensive commercial pharmaceuticals. The indictments allege that the homemade medications were not necessary and that they were only prescribed to defraud Medicare.

"In one example, Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count indictment on fraud charges. Two of Moreno's companies - Brenda Medical Supply Inc., and Faster Medical Equipment Inc. - allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno's assets, including a new Rolls Royce Phantom worth approximately $200,000. rollsroyce.jpg

Gonzales said that some of the 38 defendants allegedly paid Medicare recipients for use of their Medicare card numbers so that the defendants could submit fraudulent claims.

''We believe scores of shell companies have opened and obtained Medicare supplier numbers in Miami-Dade County alone,'' Gonzales said.

“The landscape for fraud in south Florida has changed dramatically over the past two years. CMS has taken aggressive action to curb infusion therapy fraud and other organized fraud actions,” said Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. “We have opened two satellite offices that are dedicated to combating fraud in high-risk areas and we will soon be opening a third. We are sending a strong message to those who seek to defraud the programs that if they engage in fraudulent activity, they will be caught and no longer able to take advantage of the programs to their own gain.”

May 2, 2007

Feds Charge Indiana Pediatrician with Medicare Fraud

Federal prosecutors in Indiana have charged Dr. Jihad Kasim, a Valparaiso pediatrician with health care fraud, accusing him of submitting more than $1 million in fraudulent Medicaid claims for medical services he didn't provide.

Kasim's accused of pilfering protected information from patient files who gave birth at hospitals he worked at and then using the information to submit fraudulent bills.

517764_various_contrasted_syringes_2.jpg

Kasim claimed most of the women were treated for blood infections, though the patients denied to investigators that they were ever diagnosed or treated for such conditions.

Prosecutors say Kasim has 14 bank accounts, three cars, two homes and a 20-foot speedboat.

April 30, 2007

Miami Federal Judge Slaps Lab Owner with 57-Months in Prison, Forfeits $2.8 Million

On April 18, 2007, U. S. District Court Judge Marcia G. Cooke sentenced Marcelo de Jesus Serrano, a laboratory owner, who previously pled guilty in connection with a $2.5 million Medicare billing fraud scheme to a 57-month term of imprisonment for his role in the health care fraud scheme.

Serrano also agreed to forfeit in excess of $2.8 million in cash and stock holdings, along with three Mercedes Benz automobiles and a motorcycle.

The case stemmed from a fraudulent medical laboratory billing scheme that netted Serrano and his co-conspirators more than $2.5 million in Medicare payments from 2003 through 2005. Serrano operated two clinical labs, Biocyte Laboratories, Inc., and Washington Medical Laboratory, Inc., formerly located in Hallandale Beach, Florida. To conceal his ownership interests in the labs, Serrano incorporated the labs with the State of Florida in the names of fake owners, including a deceased nursing home patient. Serrano then submitted in excess of $5 million in claims to the Medicare program for fraudulent clinical laboratory testing.