OIG CAPTURED Fugitive: Luis Perez Moreira

OIG CAPTURED Fugitive:
Luis Perez Moreira

• Luis Perez Moreira is a subject in two separate criminal investigations involving E & E Medical Services Corporation (d/b/a Elbia's Pharmacy) and Rx Plus Medical Care (Rx Plus), both based in Miami.
• In April 2010, Moreira and co-conspirator Emilio Tain were indicted on charges of Health Care Fraud and Conspiracy to Commit Health Care Fraud. As operators of Elbia's Pharmacy, Moreira and Tain allegedly submitted or caused Elbia's Pharmacy to submit more than $770,000 in fraudulent billings to Medicare for prescription drugs and other items that were not medically necessary, not prescribed by a doctor, and not provided to Medicare patients.
• UPDATE: Moreira was sentenced on September 15, 2011, to 63 months' incarceration. In September 2010, Tain pled guilty to charges of Conspiracy to Commit Health Care Fraud and was sentenced to 10 months' incarceration.
• Moreira has also been indicted on charges of Health Care Fraud and Conspiracy to Commit Health Care Fraud for his role in the operation of Rx Plus, a durable medical equipment company.
• According to the September 2010 indictment, Moreira and a co-conspirator controlled and operated Rx Plus. From August 2008 through April 2009, they allegedly submitted more than $2.5 million in fraudulent claims to Medicare, of which Medicare paid approximately $383,000.
• Investigators believe that, in order to avoid detection, Moreira and his co-conspirator recruited a nominee owner (an individual who pretends to be the owner to conceal the actual owner's identity) to use his name on the corporation's paperwork, to open bank accounts, and to sign company checks.
• Moreira was captured on June 7, 2011, at Miami International Airport. Prior to his arrest, Moreira had been living in Cancun, Mexico.

OIG CAPTURED Fugitive: Rolando Cueto

OIG CAPTURED Fugitive: Rolando Cueto

• Rolando Cueto was captured on June 30, 2011 at Miami International Airport. Prior to his arrest, he was residing in Costa Rica using a fraudulent identity.
• In September 2008, an indictment was filed charging Rolando Cueto and Juan Carlos Garcia with one count of Conspiracy to Commit Health Care Fraud and six counts of Health Care Fraud.
• Cueto was the true owner and operator of E.O. Medical Enterprises, a durable medical equipment company operating in Hialeah, Florida. E.O. Medical submitted over $1.8 million in false claims to Medicare for medical equipment that was neither ordered by a physician nor provided to the beneficiary as claimed.
• Cueto attempted to use a nominee owner to hide his involvement in the scheme. Cueto also recruited individuals to cash checks drawn on E.O. Medical's bank account, who then returned the cash to Cueto.
• Garcia pleaded guilty to one count of Conspiracy to Commit Health Care Fraud and is currently serving his 2.5-year jail sentence. Garcia was also ordered to pay over $500,000 in restitution.

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

WASHINGTON - A Miami-area psychiatrist pleaded guilty today in U.S. District Court in Miami for his part in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud.   Gumer was charged on Feb. 15, 2011, with one count of conspiracy to commit health care fraud and four counts of health care fraud.

According to court documents, Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Florida corporation headquartered in Miami.   ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.  A PHP is a form of intensive treatment for severe mental illness.

Gumer admitted that he signed evaluations, notes and other documents in medical files for patients who did not need the treatment for which ATC billed Medicare.   Specifically, as a psychiatrist, Gumer knew that the patients attending ATC did not need intensive mental health treatment, and that the treatments offered by ATC were not the type of intensive treatments a PHP should provide.   Gumer admitted that he signed these files without examining the patients, or writing and reading the statements he was signing.   Gumer also admitted to writing prescriptions for psychiatric medications for patients who did not need them in order to make it appear to Medicare that the patients qualified for PHP treatment.   According to court documents, Gumer also referred hundreds of ATC patients to a related company, the American Sleep Institute (ASI), for unnecessary diagnostic sleep disorder testing.

According to court filings, Gumer’s co-defendants and ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI.  In some cases, the patients received a portion of those kickbacks.  Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Gumer’s participation in the fraud resulted in $19.3 million in fraudulent billing to the Medicare program.   Sentencing for Gumer is scheduled for Jan 19, 2012.  Gumer faces a maximum of 10 years in prison and a $250,000 fine. 

ATC, its management company Medlink Professional Management Group Inc., and the owners and lead manager of ATC, Medlink and ASI, were charged with various health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.   Two of the three owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty and have admitted to the fraudulent scheme and that more than $200 million in billings were submitted to the Medicare program as a part of the scheme.   They are scheduled for sentencing on Sept. 14, 2011, by U.S. District Court Judge James Lawrence King.   The trial of the third owner charged in the separate superseding indictment is scheduled to begin on Aug. 15, 2011.  

The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial on Nov. 7, 2011, before U.S. District Judge Patricia A. Seitz.

An indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

         

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office. 

         

The criminal case is being prosecuted by Trial Attorney Jennifer L. Saulino of the Criminal Division’s Fraud Section.  The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

         

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants that collectively have billed the Medicare program for more than $2.3 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG are taking steps to increase accountability and decrease the presence of fraudulent providers.

HHS imposes a $4.3 million civil money penalty for violations of the HIPAA Privacy Rule

HHS imposes a $4.3 million civil money penalty for violations of the HIPAA Privacy Rule

Action marks first civil money penalty issued by HHS for HIPAA Privacy Rule violations

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.

The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Ensuring that Americans’ health information privacy is protected is vital to our health care system and a priority of this Administration. The U.S. Department of Health and Human Services is serious about enforcing individual rights guaranteed by the HIPAA Privacy Rule,” said HHS Secretary Kathleen Sebelius.

In a Notice of Proposed Determination issued Oct. 20, 2010, OCR found that Cignet violated 41 patients’ rights by denying them access to their medical records when requested between September 2008 and October 2009. These patients individually filed complaints with OCR, initiating investigations of each complaint. The HIPAA Privacy Rule requires that a covered entity provide a patient with a copy of their medical records within 30 (and no later than 60) days of the patient’s request. The CMP for these violations is $1.3 million.

During the investigations, Cignet refused to respond to OCR’s demands to produce the records. Additionally, Cignet failed to cooperate with OCR’s investigations of the complaints and produce the records in response to OCR’s subpoena. OCR filed a petition to enforce its subpoena in United States District Court and obtained a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet produced the medical records to OCR, but otherwise made no efforts to resolve the complaints through informal means.

OCR also found that Cignet failed to cooperate with OCR’s investigations on a continuing daily basis from March 17, 2009, to April 7, 2010, and that the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule. Covered entities are required under law to cooperate with the Department’s investigations. The CMP for these violations is $3 million.

“Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA’s requirements,” said OCR Director Georgina Verdugo. “The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules.”

Individuals who believe that a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security Rule may file a complaint with OCR athttp://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.

Notice of Final Determination of HIPPA Violations of Cignet

Fraud Prevention Efforts Recover $4 Billion