Medicaid Fraud Control Unit Arrests Avondale Woman

Medicaid Fraud Control Unit Arrests Avondale Woman 
Avondale-An Avondale woman has been arrested and charged with 13-counts of Medicaid fraud for filing false claims, announced Louisiana Attorney General Buddy Caldwell.

Major Principals of DME Company Sentenced for Medicare and Medicaid Fraud

Major Principals of DME Company Sentenced for Medicare and Medicaid Fraud 
TAMPA, FL-U.S. Attorney Robert E. O'Neill announces that U.S. District Judge Virginia Hernandez Covington sentenced Gregory Bane (41, Valrico), the vice president for operations and IT manager of Bane Medical Services and Oxygen and Respiratory Therapy to three years in federal prison for conspiracy to commit health care fraud, health care fraud, and submitting false claims. Tracy Bane (41, Valrico), the billing supervisor, was sentenced to six months in federal prison, and 18 months of house arrest for conspiracy to commit health care fraud, health care fraud, and submitting false claims.

Pfizer to Pay $14.5 Million for Illegal Marketing of Drug Detrol

Pfizer to Pay $14.5 Million for Illegal Marketing of Drug Detrol 
WASHINGTON - American pharmaceutical company Pfizer Inc. has agreed to pay $14.5 million to resolve False Claims Act allegations related to its marketing of the drug Detrol, the Justice Department announced today. The settlement resolves the last of a group of 10 qui tam, or whistleblower, suits that were filed in the District of Massachusetts and two other districts, beginning in 2003. The other nine suits were settled or dismissed in 2009 as part of the government's global resolution with Pfizer, under which the company agreed to pay $2.3 billion dollars to resolve civil claims and criminal charges regarding multiple drugs.

HILL-ROM COMPANY, INC. WILL PAY $41.8 MILLION TO RESOLVE FEDERAL HEALTH CARE FRAUD INVESTIGATION

HILL-ROM COMPANY, INC. WILL PAY $41.8 MILLION TO RESOLVE FEDERAL HEALTH CARE FRAUD INVESTIGATION

KNOXVILLE, Tenn. - Hill-Rom Company, Inc., one of the largest national suppliers of durable medical equipment, has agreed to pay $41.8 million to settle alleged violations of the federal False Claims Act and other federal laws and regulations. This is the largest civil fraud recovery ever by the U.S. Attorney's Office for the Eastern District of Tennessee.

The United States' investigation revealed that for a number of years Hill-Rom knowingly submitted numerous and repeated false claims to the Medicare program for certain specialized medical equipment – bed support surfaces for treatment of pressure ulcers or bed sores – for patients who did not qualify for this equipment. Hill-Rom submitted these false claims for patients for whom the equipment was not medically necessary, including claims for patients who had died or were no longer using the equipment. Hill-Rom had a practice of automatically billing for patients over long periods of time without making any reasonable effort to determine if the patients for whom it submitted the claims continued to meet Medicare conditions for payment. At the time it submitted these false claims, Hill-Rom was well aware of the Medicare laws and rules regarding coverage and claims for this equipment and its ongoing obligation to reasonably follow the condition of its patients.

The federal False Claims Act is intended to provide a means for the United States to recover moneys paid by federal programs to persons and companies who have knowingly sought and received funds to which they were not entitled. The payment Hill-Rom must now make in connection with this settlement is to compensate the Medicare trust fund for the moneys paid out of that fund which Hill-Rom improperly claimed and received during the period from 1999 through 2007. As part of this overall settlement, Hill-Rom has also entered into a comprehensive five-year Corporate Integrity Agreement with the U. S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) to ensure its future compliance with federal health care benefit program requirements.

"Today's settlement is an example of the determination of both the Justice Department and the Department of Health and Human Services to enforce the federal False Claims Act and to protect the Medicare trust funds to ensure that the Medicare program remains viable to provide health care for today's seniors and disabled citizens as well as for the next generation," said U.S. Attorney Bill Killian.

"Too many giant corporations make business decisions believing that they are immune from charges of Medicare fraud," said Derrick Jackson, Special Agent in Charge of the federal Health and Human Services Department, Office of Inspector General's region covering Tennessee. "This settlement puts companies on notice that, no matter their size, violating Medicare regulations will lead to investigation and prosecution."

U.S. Attorney Killian further noted that this settlement resolves a comprehensive investigation into Hill-Rom's Medicare billing practices which began as a result of allegations brought by two Hill-Rom former and current employees. Laurie Salmons and Lisa Brocco, both trained nurses who served as sales representatives for Hill-Rom, through their attorney David Burkhalter, filed an action on behalf of the United States under the qui tam, commonly-known as whistle-blower, provisions of the federal False Claims Act. Under the terms of the settlement agreement and as authorized by the False Claims Act, Salmons and Brocco are to receive jointly over $8 million from the proceeds of the settlement for their role in filing the qui tam complaint and actively assisting with the investigation.

The investigative team whose diligent efforts resulted in this settlement was comprised of representatives from the HHS-OIG, Federal Bureau of Investigation (FBI), Railroad Retirement Board Office of Inspector General (RRB-OIG), U.S. Attorney's Offices for the Eastern District of Tennessee (USAO-TNE) and the District of South Carolina (USAO-SC), and U.S. Department of Justice (DOJ). Assistant U.S. Attorneys (AUSAs) Betsy Tonkin, Rob McConkey and Will Mackie represented the United States.

U. S. Attorney Killian commended the dedication and diligence of all who played a role in this complex investigation, in particular lead HHS-OIG Special Agent Tony Maffei, FBI Forensic Accountant/Certified Fraud Examiner LeAnn Lanz, RRB-OIG Special Agent Tom Tamburello, USAO -TNE paralegal Susan Page, USAO-TNE contract paralegal Renee Lange, and AUSAs Betsy Tonkin, Rob McConkey and Will Mackie for their oversight of the parallel civil and criminal investigation for the U.S. Attorney's Office. U.S. Attorney Killian also recognized the assistance of AUSAs Jennifer Aldrich and Fran Trapp from the USAO-SC, HHS-OIG Senior Counsel Tonya Keusseyan and DOJ Trial Counsel Tom Morris.

WRIGHT MEDICAL TECHNOLOGY, INC. DEFERRED PROSECUTION AGREEMENT WITH GOVERNMENT EXTENDED FOR 12 MONTHS

FOR IMMEDIATE RELEASE September 15, 2011 www.justice.gov/usao/nj

CONTACT:

Rebekah Carmichael Office of Public Affairs (973) 645-2888

NEWARK, N.J. – The 12-month Deferred Prosecution Agreement executed in September 2010 by Wright Medical Technology, Inc. – a publicly-traded national manufacturer and distributor of orthopaedic implant devices and supplies based in Arlington, Tenn. – has been extended by another 12 months, First Assistant U.S. Attorney J. Gilmore Childers announced.

The Deferred Prosecution Agreement (DPA) was set to expire Sept. 29, 2011. A related criminal Complaint alleging that Wright used consulting agreements with orthopaedic surgeons as an inducement to use its artificial hip and knee reconstruction products was to have been dismissed after the expiration of the DPA. Instead, Wright has voluntarily agreed to a 12-month extension of the terms of the DPA, as outlined in an Addendum and Amendment to the DPA filed today in Newark federal court.

Under the original terms of the DPA, the agreement could only have been extended for a period of six months, for a total period of 18 months; the DPA Addendum extends the total period of the monitorship to 24 months. Provided that Wright meets all of the requirements of the DPA Addendum, the agreement will expire on Sept. 29, 2012, and the Criminal Complaint will thereafter be dismissed.

Pursuant to the terms of the DPA, Wright had agreed to accept the appointment of a federal monitor to, among other things, review its compliance with the terms of the DPA. Since September 2010, Wright has been monitored by James B. Tucker, former U.S. Attorney for the Southern District of Mississippi.

In the last several months, Wright has undergone extensive changes in senior management. On April 5, 2011, Wright announced that its then-president and CEO had tendered his resignation prior to a board meeting called to discuss management’s oversight of the company’s compliance program. On that same day, Wright announced that it had terminated its senior vice president and chief technology officer for cause – for failing to exhibit appropriate regard for the ongoing compliance program. On May 4, 2011, Wright announced the resignations of three executives without “good reason,” including the general counsel.

By letter dated May 5, 2011, the Office notified Wright that it had received information that Wright had knowingly and willfully breached material provisions of the DPA. To date, the U.S. Attorney’s Office has not made a determination on whether there has been a material, knowing, and willful breach of the DPA that has not been adequately cured. Under the terms of the DPA Addendum, if the Office does not find by Sept. 29, 2012 that Wright has committed such a breach, the U.S. Attorney’s Office will take no further action regarding any breach of the DPA referenced in the May 5 letter. In exchange, the material terms of the DPA remain unaltered and in effect for another 12 months; the only exception is that the DPA Addendum requires only three monitor reports during the twelve-month extension period, rather than four as required in the first year.

Based on the amendment to the DPA, the Department of Health and Human Services Office of Inspector General (HHS-OIG) and Wright also amended Wright’s Corporate Integrity Agreement (“CIA”) to continue the suspension of certain CIA provisions during the extended period of the DPA. The amendment does not extend the suspension of one provision, regarding compliance with the anti-kickback statute, which will take effect on Sept. 29, 2011. This provision requires Wright to adopt certain procedures governing its handling of arrangements with actual sources of health care business or referrals to Wright.

“As a direct result of the federal monitorship, Wright has made significant and wide-ranging changes in corporate culture and tone at the top,” First Assistant U.S. Attorney Childers said. “Our Office is pleased with the extensive cooperation from the newly-appointed interim senior management team. Today’s extension will allow Wright to make the transition from interim to permanent senior management while still under the terms of the DPA and the surveillance of the federal monitor.”

First Assistant U.S. Attorney Childers credited special agents of HHS-OIG, New York Regional Office, under the direction of Special Agent in Charge Tom F. ODonnell; and special agents of the U.S. Postal Inspection Service, under the direction of Inspector in Charge Philip R. Bartlett, for their work in reaching the original agreement.

The government is represented by Assistant U.S. Attorney Joseph Mack of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.

11-373                                                                                         ###

Defense counsel: Karen F. Green Esq., Boston

Wright Medical Deferred Prosecution Agreement Extension

OIG CAPTURED Fugitive: Steven Moos

OIG CAPTURED Fugitive:
Steven Moos

• Steven Moos is charged with drug possession, fraudulent Internet marketing, and child endangerment.
• Formerly a general practice physician in Oregon, Moos lost his medical license after he repeatedly prescribed numerous prescription drugs over the Internet, despite warnings from the State medical authorities to stop such practices.
• According to the Oregon Board of Medical Examiners, Moos prescribed drugs and refilled prescriptions without physically examining patients or obtaining health record information from them or their primary care providers.
• After his medical license was revoked, Moos allegedly continued to practice medicine and prescribe drugs and made false statements on a Drug Enforcement Administration registration renewal application to conceal the fact that he no longer had a medical license to prescribe drugs, according to the indictment.
• The Federal indictment stated that in the summer of 2002, Moos allegedly ordered misbranded drugs (including human growth hormone) from China. The drugs did not have adequate directions for use or warnings and other required information.
• On April 19, 2011, in the United States District Court, District of Oregon, Moos pleaded guilty to a single count of the Indictment (Title 18 U.S.C. 1001 and 2 - False Claims and Statements). Moos was sentenced to serve 4 months of home detention, 3 years of probation, and 200 hours of volunteer community service.

OIG CAPTURED Fugitive: Reynel Betancourt

OIG CAPTURED Fugitive:
Reynel Betancourt

• Reynel Betancourt was sentenced on June 7, 2011, to 77 months in prison and ordered to pay approximately $6 million in restitution, joint and several, after pleading guilty to charges of conspiracy to commit health care fraud and conspiracy to commit money laundering.
• From about March 2006 to March 2007, Betancourt worked at the Dearborn Medical and Rehabilitation Center (DMRC), an infusion therapy clinic in Michigan, which was owned and operated by sisters Clara and Caridad Guilarte.
• Betancourt and his co-conspirators entered into an agreement to pay Medicare beneficiaries to receive treatments at DMRC. The infusion therapy clinic then submitted over $9 million in false and fraudulent claims to Medicare for services that were medically unnecessary or never provided.
• The Guilarte sisters were captured in Colombia on March 13, 2011, and are awaiting trial.
• On November 30, 2010, authorities captured Betancourt in the Dominican Republic.

OIG CAPTURED Fugitive: Zoya Belov

OIG CAPTURED Fugitive:
Zoya Belov

• Zoya Belov, who with co-conspirators allegedly defrauded the Medicare program, was captured on March 23, 2011 at the San Francisco International Airport.
• The purported leader of the conspiracy, Vardges Egiazarian, owned three medical clinics in eastern California (specifically, in Sacramento, Richmond and Carmichael). From February 2006 to August 2008, these clinics allegedly submitted a total of nearly $5.2 million worth of false billings to Medicare, of which Medicare paid approximately $1.5 million. Belov, a medical assistant at the clinics, falsely claimed to have performed medical tests on patients, and requested reimbursements from Medicare, OIG alleges.
• The fraud was purportedly accomplished by recruiting and paying third parties to pretend to be "patients" who wished to receive medical treatment at one of the alleged conspirators' clinics. Normally, patients must pay for a certain portion of their medical expenses, and Medicare may pay the remainder. In this fraud, the individuals pretending to be patients were paid by the conspirators to state that they needed medical treatment when they did not.
• Belov would allegedly perform unnecessary medical tests on the patients, or fraudulently claim to have performed the tests when she had not. Belov and others then submitted the fraudulent claims to Medicare for medical services that were not performed, not performed as billed, or unnecessary, according to OIG.
• In an attempt to conceal the alleged fraud from Medicare representatives, Belov allegedly lied about the whereabouts and activities of the other conspirators.

OIG CAPTURED Fugitives: Clara Guilarte and Caridad Guilarte

OIG CAPTURED Fugitives:
Clara Guilarte and Caridad Guilarte

• Sisters Clara and Caridad Guilarte were captured in Colombia on March 13, 2011.
• Along with previously captured co-conspirator Reynel Betancourt, the Guilartes allegedly defrauded Medicare of nearly $4.3 million (and submitted $9.1 million in false and fraudulent claims), according to a Federal indictment.
• The Guilartes operated the Dearborn Medical and Rehabilitation Center (DMRC), an infusion therapy clinic in Michigan, where Betancourt was an employee.
• All three fugitives allegedly committed health care fraud, conspiracy, and money laundering. The trio allegedly recruited and paid cash and other inducements to Medicare beneficiaries to visit DMRC and sign forms indicating that they received legitimate medical services, including injections and infusions of expensive medications, although the services allegedly were never provided.

Return to Captured Fugitives

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.

Medicaid Fraud In Costs U.S. More than $90 Billion A Year

Medicaid fraud in child welfare costs more than $90 billion a year.



Stop Child Medicaid Fraud

IG Daniel R. Levinson Speaks at Nationwide Medicare Fraud Takedown Press Conference (EXCERPT)

Nebraska Joe Bruning Advocates Medicaid Fraud In Child Welfare

I posted this almost 4 years ago.  In honor of Nebraska's Auditor General Report on posthumous payments, I have dedicated this piece on privatization to them.

Privatization can be fiscally responsible.

The Detroit News

This was published 10/31/07 06:09 PM

The Governor should embrace with joy the championing of privatization of foster care and adoption services by Senator Hardiman. This is what we all have been awaiting.

Privatizing foster care and adoption services releases the constraints of enforcement within the executive branch. The Attorney General is now able to flick the switch of the oversight machine and provide accountability for the state and its families. This is what is to happen:

The responsibility of contract monitoring and compliance is transferred from DHS back into the hands of the Attorney General. For example, families whose children have been removed where privatized agencies do not believe in family reunification, can now file complaints with the Attorney General regarding protection of consumer rights. The Bureau of Children and Family Services Fraud Division may now protect, not just vulnerable adults, but vulnerable children and families.

When the Attorney General conducts investigations and finds material violations of law and policy by the privatized child placing agencies, he is now allowed to follow through with full prosecution of the agencies and their workers.

In turn, families are provided proactive services, there are no longer phantom programs funded by DHS, tens of millions of dollars in improper payments of improper, unneccessary services and placements of children in foster care are ameliorated.

The number of children entering foster care are reduced because privatized child placing agencies must promote and advocate for placement of children within the family which is more cost effective than having a child prescribed psychiatric medication to "calm" from the trauma of being ripped from his/her home and placed in a strangers home, further reducing medicaid waste and fraud.

Privatized child placing agencies, under the theory of punishment by deterrence, will produce accurate and transparent audit reports, simply from the fear of prosecution.

Practices of targeting minority and impoverished children, due to the fact that child abuse and neglect is an entitlement program, will cease in the face of civil rights penalties.

Michigan will become a model state for accountability and transparency by reducing dependency of federal funding streams in Social Security. The money saved by privatized child placing agencies can be invested in education, thus, replacing the state's number one industry (Human Services) with higher education.

Michigan is no longer liable for litigation. The Executive Office is no longer a demagogue to privatized child placing agencies who also lobby (many without proper IRS status), but becomes the fiscal savior of our families.

Everyone wins...except the privatized child placing agencies that violate federal and state laws and policies, under color of state law.

Beverly Tran

Where the hell is the Attorney General?  

Hey Joe, get off your lazy punk ass and get that Medicaid Fraud Control Unit up and do something.  Damn.  Just sad.  Maybe you might want to keep screaming about too much regulation particularly the antifraud provisions in the Obamacare.  Moron.

Seriously, listen to him.  Here he is referring to welfare recipients as "raccoons".  He has to know that when the families are cut off, the children go to foster care... wait, he does know what he is talking about.  The privatized child placing agencies are making a killing on Medicaid fraud.

This is why his Medicaid Fraud Control Unit allows fraud to flourish in child welfare.  

Medicaid Integrity Program Nebraska Comprehensive Program Integrity Review Final Report December 2010

California Medical Billing Company Agrees to Pay U.S. $4.6 Million to Resolve Allegations of False Claims to Federal Health Care Programs

California Medical Billing Company Agrees to Pay U.S. $4.6 Million to Resolve Allegations of False Claims to Federal Health Care Programs

WASHINGTON – Janzen, Johnston & Rockwell Emergency Medicine Management Services   Inc. (JJ&R), a provider of billing services for physicians, hospitals and other health care providers, has agreed to pay the United States $4.6 million to settle allegations that it submitted false claims to Medicare and Louisiana’s Medicaid program, the Justice Department announced today. JJ&R is headquartered in El Segundo, Calif.    

Today’s settlement resolves allegations that JJ&R inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California.   From approximately 2000 through 2007, JJ&R utilized a coding formula that had a tendency to generate claims for a marginally higher level of evaluation and management service than the physicians had actually provided.   In addition, JJ&R routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians.  

Finally, during this time period, JJ&R often failed to comply with Medicare’s coding rules governing the submission of claims for teaching physicians, resulting in the submission of claims that were not properly payable.   While these coding practices had a relatively small impact on the reimbursement of any particular claim, over time they generated significant overpayments from Medicare and Medicaid.

“Inflating individual health care claims by even small amounts can cause significant losses to Medicare and Medicaid,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice.  “Taxpayers should not be on the hook for charges that shouldn’t have been added or claims that shouldn’t have been submitted.” 

“ In Louisiana’s Middle District we are committed to using all available tools, including affirmative civil actions, to combat health care fraud,” said Donald J. Cazayoux Jr., U.S. Attorney for the Middle District of Alabama.

“The Office of the Inspector General recognizes and appreciates the importance of whistleblowers in the fight against health care fraud,” said William W. Root, Assistant Special Agent-in-Charge for the U.S. Department of Health and Human Services (HHS).

Today’s settlement resolves allegations that were the subject of a federal investigation and a lawsuit brought by Le Jeanne Harris, a former employee of JJ&R. The lawsuit was filed under the False Claims Act, which enables private persons to sue on behalf of the United States, and to receive a share of any recovery.   In this case, Ms. Harris will receive $774,450.

This matter was handled by the U.S. Attorney’s Office for the Middle District of Louisiana, as well as HHS Office of the Inspector General (OIG) and the Commercial Litigation Branch - Fraud Section of the Justice Department’s Civil Division. HHS-OIG investigated the matter.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of HHS, in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $5.9 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are more than $7.5 billion.

45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)

45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)

September 7, 2011

FOR IMMEDIATE RELEASE

91 Defendants Charged Nationally for Submitting More than $295 Million in Fraudulent Billing

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced charges against forty-five (45) individuals and one corporation as part of a nationwide enforcement operation by HEAT Task Force Teams. The 46 South Florida defendants are allegedly responsible for more than $160 million in false billings to Medicare.

In addition, as part of a coordinated national HEAT health care fraud takedown, the Department of Justice announced that 45 additional defendants were charged by HEAT teams in other cities, including Detroit, Los Angeles, Brooklyn, Houston, Dallas, Chicago, and Baton Rouge. Collectively, the 91 defendants, including doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints, are accused of conspiring to submit a total of more than $295 million in fraudulent billing.

The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

U.S. Attorney Wifredo A. Ferrer stated, “The South Florida defendants, including clinic owners, a doctor, a nurse, mental health and family counselors, and patient recruiters, engaged in more than $160 million in Medicare fraud. In a new twist to the ever-changing Medicare fraud schemes, some of the defendants went as far as to recruit vulnerable out of state Medicare patients who were down on their luck or suffering from drug or alcohol addiction. The defendants promised the patients a roof over their heads in halfway houses as long as they received community mental health services that they did not need. If the patients refused the treatments, they were threatened with eviction and thrown out on the street. This conduct is outrageous and will not be tolerated. We will continue to fight the battle against health care fraud on all fronts, whether in community mental health care, home health care, HIV-infusion therapy, and durable medical equipment fraud.”

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare - jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive - or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

“South Florida is ground zero for health care fraud. The FBI and its partners devote vast resources to investigate, catch and prosecute those committing health care fraud,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “To attack the problem from both ends, tougher regulation and oversight are key to reducing the amount of fraud in the first place.”

HHS-OIG Special Agent in Charge Christopher B. Dennis stated, “These 45 indicted individuals are representative of the OIG’s commitment to root out Medicare fraud in South Florida. The OIG will continue to identify, locate, and charge those responsible for stealing from the Medicare trust fund and ultimately the American taxpayer.”

The South Florida cases announced as part of the nationwide HEAT Enforcement Operation include:

United States v. Antonio Macli, et al.
United States v. Rufus Cargile
United States v. John Jackson
United States v. Sabrina Pressley

In these four separate cases, a total of twenty-three (23) individual defendants and one corporation (Biscayne Milieu) are charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive health care kickbacks, payment and receipt of health care kickbacks, conspiracy to launder money, and money laundering in connection with the operation of Biscayne Milieu Health Center, Inc. (Biscayne Milieu), a community mental health center. According to the charges, Biscayne Milieu purported to provide a partial hospitalization program (PHP) for Medicare beneficiaries suffering from mental illnesses. In fact, however, the defendants devised a scheme in which they paid patient recruiters and even doctors to refer ineligible Medicare beneficiaries to Biscayne Milieu for purported PHP services. Indeed, some of the patients admitted to Biscayne Milieu were not eligible for PHP because they suffered from severe dementia or Alzheimer’s disease and would not benefit from group therapy. The indictment alleges that from January 2007 to June 2011, Biscayne Milieu submitted more than $50 million in fraudulent claims. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

United States v. Ramchand Ramrup
United States v. Joseph B. Williams, et. al.
United States v. Robert Jenkins, et. al.
United States v. Robert Revels, et. al.
United States v. Barry Nash
United States v. Isabel Roque
United States v. Irene Trematerra

In this group of cases, ten (10) defendants were charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. According to court documents, from 2005 through 2010, the defendants variously participated in a fraudulent scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink). ATC purportedly provided partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. ATC’s owners and operators purportedly paid kickbacks to owners and operators of assisted living facilities, including, for example, Boynton Beach Assisted Living Facility, in Boynton Beach, and Avondale Manor Retirement Home, in Pompano Beach, and halfway houses and to other patient recruiters. In exchange, the defendants delivered ineligible Medicare beneficiaries to ATC. Throughout the course of the fraudulent scheme, ATC billed Medicare more than $200 million for the medically unnecessary services and for services that were never provided. These cases are being prosecuted by Acting Assistant Chief Benjamin Singer and Trial Attorneys Steven Kim and Jennifer Saulino of the Department of Justice, Criminal Division, Fraud Section.

United States v. Marietha Morales, et. al.
United States v. Ariel Rodriguez, et al.
United States v. Roberto Gonzalez, et. al.

In these related cases, nine (9) defendants were charged with conspiracy to commit health care fraud and conspiracy to pay health care kickbacks. According to the charges, the defendants owned and operated home health care agencies that purported to provide home health care to homebound Medicare beneficiaries who were insulin-dependent but could not self-medicate. In fact, however, the defendants paid kickbacks to patient recruiters, who referred ineligible beneficiaries to the defendants’ home health companies. The defendants obtained fraudulent prescriptions and other medical documentation ordering home health services for the beneficiaries and falsified documentation indicating that the services had been provided. In fact, the beneficiaries did not require or receive home health services.

In this way, three home health companies owned and operated by the defendants billed Medicare for more than $100 million. More specifically, Prime Home Health, operated by defendants Marietha Morales and Eduardo Dominguez, submitted approximately $22 million in false Medicare claims for services purportedly provided to approximately 500 beneficiaries from April 2007 through April 2011. Serendipity Home Health, operated by defendants Ariel Rodriguez, Reynaldo Navarro, Melissa Rodriguez and Ysel Salado, submitted approximately $21 million in false Medicare claims for services purportedly provided to approximately 519 beneficiaries from April 2007 through March 2009. Nany Home Health, operated by defendants Roberto Gonzalez, Olga Gonzalez, and Fabian Gonzalez, submitted approximately $60 million in false Medicare claims for services purportedly provided to approximately 1474 beneficiaries from January 2006 through November 2009. These cases are being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Department of Justice, Criminal Division, Fraud Section.

United States v. Maratib Hashmi

Maratib Hashmi, of Miami, Florida, is charged with conspiracy to commit health care fraud, health care fraud, and money laundering. According to the indictment, Hashmi operated L’Image Physical Therapy and Rehabilitation, Inc., a Miami-Dade medical clinic that purportedly provided physical and occupational therapy to Medicare beneficiaries. From September 2009 through March 2010, Hashmi submitted approximately $1.2 million in false Medicare claims for outpatient physical and occupational therapy purportedly provided by L’Image. This case is being prosecuted by Assistant U.S. Attorney Adam Schwartz.

United States v. Clara Luz Varona

Clara Luz Varona, of Miami, is charged with conspiracy to commit health care fraud and health care fraud. According to the indictment, Varona co-owned A&C Medical Supplies Inc., a Miami-Dade durable medical equipment company that purportedly provided medical supplies to Medicare beneficiaries. The indictment alleges that between January 2005 and July 2009, Varona submitted false Medicare claims for approximately $1.8 million in medical supplies purportedly provided by A&C. Based on these claims, Medicare paid A&C approximately $1.1 million. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

United States v. Oscar Hernandez

Oscar Hernandez, of Miami, is charged with conspiracy to commit money laundering. According to the Information, from May 2009 to June 2009, Hernandez assisted the owners of two fraudulent durable medical equipment companies by laundering $316,750 in Medicare fraud proceeds by cashing corporate checks made out to phony shell corporations. Hernandez received a percentage of the cashed checks as his fee. This case is being prosecuted by Assistant U.S. Attorney Chris Clark.

United States v. Reina Addis Masson

Reina Addis Masson, of Hialeah Gardens, is charged with conspiracy to commit health care fraud, health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. The indictment alleges that Masson worked at A’s Medical Center (“AMC”), a medical clinic that purported to treat HIV positive Medicare beneficiaries. From October 2005 to December 2006, AMC submitted approximately $4.1 million in false claims for treatment of HIV therapy. Based on these claims, Medicare paid AMC approximately $700,000. At various times, Masson worked as a medical assistant, a patient recruiter, and a biller for AMC. This case is being prosecuted by Economic Crimes Deputy Chief Marc Osborne.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS 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.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG.

An indictment or information is merely a charge and defendants are presumed innocent until proven guilty.

Anyone with information regarding their whereabouts should call the FBI in Miami at (305) 944-9101.

Attachments:
Eduardo Dominguez (JPG)
Debora De Jesus (JPG)
James Wynn (JPG)

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or onhttp://pacer.flsd.uscourts.gov.

Technical comments about this website can be e-mailed to the Webmaster. PLEASE NOTE: The United States Attorney's Office does not respond to non-technical inquiries made to this website. If you wish to make a request for information, you may contact our office at 305-961-9001, or you may send a written inquiry to the United States Attorney's Office, Southern District of Florida, 99 NE 4th Street, Miami, Fl. 33132.