Miami Physician Sentenced to 97 Months in HIV Infusion Fraud
MIAMI, FL (June 29) In the ongoing prosecutions by the joint DOJ-HHS task force, another physician, Roberto Rodriguez was sentenced to 97 months in prison and ordered to pay over $9,000,000 in restitution in connection with $20,000,000 in fraudulent claims submitted to Medicare through 4 clinics associated with the doctor. The physician had pled guilty in March. To read the plea agreement click here, and to read the factual proffer click here.
In this, as in many of the ongoing prosecutions related to this subject matter, the allegation was that expensive drugs related to the treatment of HIV symptoms were claimed to have been administered to patients, many of whom did not have HIV. Most of the drugs were not purchased by the clinics at all. To read the indictment, click here.
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“Sweeps” among law enforcement are generally used in high drug crime areas to literally sweep in and arrest as many people as possible to clear out the drug dealing in that area. 
Some 60 defendants charged with Medicare Fraud in the Southern District of Florida have fled pending trial since 2004. Many who have fled are of Cuban origin, leading authorities to conclude that they have returned to Cuba, which is generally out of reach of U.S. law enforcement. 
Telemarketers in Houston are pushing “Medicare approved arthritis kits” that are really an assortment of DME and prosthetic devices billed to Medicare individually. 
The term “medically necessary” in the context of Medicare and Medicaid reimbursement has been under some scrutiny lately. Medicare defines "medical necessity" as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Medicaid has a similar definition. For items or services where there is no specific limitation based upon a coverage policy, medical necessity has often been left to the good faith determination of a physician. However, in several prosecutions of physicians for infusion of HIV drugs, the government has relied on fraudulent diagnosis or unnecessary prescribing of medications as a basis of prosecution, citing to the physician motive of profit over appropriate patient care. In addition, the 11th Circuit Court of Appeals in Atlanta has recently held that the Medicaid program in Georgia can overrule a physician’s determination of medical necessity. 
In addition to the conspiracy charge, Tony Marrero is charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Pascual is also charged with six counts of health care fraud, two counts of money-laundering conspiracy and four counts of money laundering. Belkis Marrero is additionally charged with six counts of health care fraud, one count of money-laundering conspiracy and one count of money laundering. In addition to the conspiracy charge, Rothman and Borrego are each charged with four counts of health care fraud, and Milanes, Russell and Pacheco are each charged with two counts of health care fraud. The indictment also seeks forfeiture from all defendants.
According to the indictment, Tony Marrero, Pascual and Belkis Marrero controlled the day-to-day operations of two Miami medical clinics: Medcore Group LLC (Medcore) and M&P Group of South Florida Inc. (M&P). As medical assistants, Borrego (at Medcore), Pacheco (at M&P) and Milanes (at M&P) provided unneeded HIV infusion treatments to paid patients. The indictment charges that Pascual, Borrego and Milanes delivered cash payments to the patients. Furthermore, the indictment charges Rothman with ordering the unnecessary treatments at Medcore, and Russell with ordering the unnecessary treatments at M&P. Rothman and Russell allegedly conducted cursory examinations of the beneficiaries and signed the required documentation, including medical and billing records, to make it appear that the injection and infusion treatments billed by Medcore and M&P were medically necessary and provided, when, in fact, they were not.
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 
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.
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 
MIAMI (July 11, 2008). Yesterday the Bureau of National Affairs first reported another case rejecting the government’s methodology of computing “loss” in health fraud cases under the federal sentencing guidelines in the Southern District of Florida.
Check 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.
On April 2, the same day that seven co-defendants were indicted 
billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.
commit health care fraud violations and conspiracy to commit structuring violations. Defendant Perez had pled guilty to conspiracy to structure financial transactions.
According 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.
