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.

Miami-Area Halfway House Owner Pleads Guilty to Fraud and Kickback Scheme

Miami-Area Halfway House Owner Pleads Guilty to Fraud and Kickback Scheme 
WASHINGTON - The owner and president of a Miami-area halfway house company pleaded guilty today for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), and its related company, the American Sleep Institute (ASI), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Owners of Fraudulent Lakeland, Florida, Physical Therapy Company Sentenced to 42 and 46 Months in Prison

Owners of Fraudulent Lakeland, Florida, Physical Therapy Company Sentenced to 42 and 46 Months in Prison 
WASHINGTON - Miami-area residents Angel Gonzalez and Jorge Zamora, who were the owners and operators of a fraudulent physical therapy company in Lakeland, Fla., were sentenced yesterday and today to 42 months in prison and 46 months in prison, respectively, for their leading roles in a scheme to defraud Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services.

Twenty-Four Indicted In Oxycodone Trafficking And Health Care Fraud Scheme

Twenty-Four Indicted In Oxycodone Trafficking And Health Care Fraud Scheme 
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Mark R. Trouville, Special Agent in Charge, Drug Enforcement Administration, Christopher B. Dennis, Special Agent in Charge, Health and Human Services, Office of Inspector General, Jos� A. Gonzalez, IRS Special Agent in Charge, Director James K. Loftus, Miami-Dade Police Department, Al Lamberti, Sheriff, Broward Sheriff's Office, and H. Frank Farmer, M.D., State Surgeon General, Florida Department of Health (DOH), announced the unsealing of a federal indictment charging twenty four defendants for their participation in, among other things, conspiracy to distribute oxycodone and oxymorphone, and conspiracy to defraud Medicare. Twenty-one of the defendants, including a doctor, a pharmacist and two pain clinic operators are currently in custody after a multi-agency takedown was executed early this morning. Three defendants, Hattie Mae Green, Eliezer Salgado and Ronald Regains, remain at large.

Dope Smok’n Largo Psych in Trouble with the Department of Health

Dope Smok’n Largo Psych in Trouble with the Department of Health

Sep 20th, 2011 | By admin | Category: Drug Use, Joel Voss

Largo Psychiatrist
Ronald Lee Knaus

Psych News
By Joel Voss

Largo, Florida psychiatrist Ronald Knaus was arrested on July 2, 2010 in nearby Clearwater for possession of marijuana. The police initially approached him due to a handgun in his waistband, per the police report. He pleaded no-contest in open court and was sentenced.

But the story does not end there. In Florida, all licensed health care professionals must report any and all criminal cases against them to the Florida Department of Health within 30 days unless they are acquitted or the charges are dismissed. Also, all physicians must update their profile on the department’s website to reflect any criminals convictions.

The Citizens Commission on Human Rights, Tampa, Florida Chapter found out about Knaus’s case and reported it to the department.

Earlier this month the Florida Department of Health filed their own administrative complaint against him, charging Knaus with withholding his drug case and not updating his online profile on their website. They are seeking discipline ranging from fines to revocation of his license.

In March 2008 a mother attacked her 15 year old son with a dagger and drywall knife at Kanus’ clinic at 1301 Seminole Blvd, Bldg B, Suite 112 in Largo.
The boy survived but was hospitalized. Knaus’ clinic was hired to provide a safe & supervised visitation of the mother and son. The boy’s father filed a lawsuit that is ongoing at this time.

Knaus was reported to be one of the Kings of the Baker Act, the Florida law governing involuntary commitment. It was reported in 1995 by the St Petersburg Times that Knaus was one of 3 psychiatrists in Pinellas County, Florida that accounted for half of the all involuntary commitments to mental hospitals in the county. Knaus committed people to a hospital that he was an investor in, the report stated.

Former President of Fraudulent Florida Physical Therapy Company Sentenced to 24 Months in Prison for Medicare Fraud Scheme

Former President of Fraudulent Florida Physical Therapy Company Sentenced to 24 Months in Prison for Medicare Fraud Scheme

WASHINGTON – The former president and administrator of a fraudulent physical therapy company in Lakeland, Fla., was sentenced today to 24 months in prison for his role in a scheme to defraud Medicare, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Miami-area resident Adrian Chalarca, 24, also was sentenced by U.S. District Judge James D. Whittemore of the Middle District of Florida to serve three years of supervised release following his prison term and ordered to pay $82,765 in restitution, jointly and severally with his co-defendants.  Chalarca pleaded guilty on June 10, 2011, before U.S. Magistrate Judge Mark A. Pizzo in Tampa, Fla., to one count of conspiracy to commit health care fraud.

According to court documents, Chalarca and his co-conspirators purchased Dynamic from its prior owners and transformed it into a fraudulent enterprise.  Under Chalarca and others, Dynamic purported to provide physical therapy services to Medicare beneficiaries. 

According to court documents, from fall 2009 to summer 2010, Chalarca submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program.  Chalarca admitted that he paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information and used it to submit claims to Medicare for physical therapy services that were never provided.  Chalarca admitted that he knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services. 

All five defendants charged for their roles in the scheme at Dynamic have pleaded guilty.  On Aug. 29, 2011, co-defendant Andres Cespedes was sentenced to 21 months in prison for his participation in the fraud scheme. 

Today’s sentencing was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Robert E. O’Neill of the Middle District of Florida; Steven E. Ibison, Special Agent-in-Charge of the FBI’s Tampa Division; and Christopher Dennis, Special Agent-in-Charge of the HHS Office of Inspector General (HHS-OIG), Office of Investigations’ Miami Office.

This case was prosecuted by Acting Assistant Chief Benjamin D. Singer of the Criminal Division’s Fraud Section and Special Assistant U.S. Attorney Christina M. Burden of the Middle District of Florida.  The case was investigated by the HHS-OIG, Defense Criminal Investigative Service and FBI, 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 Middle District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants that collectively have 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go towww.stopmedicarefraud.gov.

Owner of Miami-Area Mental Health Company Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

Owner of Miami-Area Mental Health Company Sentenced to 35 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

WASHINGTON – Miami resident Marianella Valera, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 35 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Valera, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida.   Judge King ordered Valera to pay more than $87 million in restitution, jointly and severally with her co-defendants.   Valera was also sentenced to three years of supervised release following her prison term.   Lawrence Duran, another owner of ATC, was sentenced on Sept. 16, 2011, to 50 years in prison for his role in the fraud scheme.   Duran’s sentence is the longest prison sentence ever imposed in a Medicare Fraud Strike Force case.

On April 14, 2011, Valera and Duran pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011.   The superseding indictment charged Valera with 21 felony counts and Duran with 38 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.   Valera and Duran were remanded to the custody of the U.S. Marshals Service after their arrest on Oct.   21, 2010, and have been detained since that time.   Their assets were restrained at the time of their arrests through civil proceedings.  

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010.   Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported 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.   Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients.   According to court documents, the treatments were medically unnecessary or never provided at all.   Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash.   The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement.  

As part of the fraud scheme, Duran, Valera and others 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.  The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme.   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 $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments.   According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services.   Duran, Valera and co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies.  

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries.   According to court documents, Duran and Valera used another company they owned and operated, Medlink Professional Management Inc., to conceal the health care fraud and kickbacks from Medicare and law enforcement.   Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred millions of dollars to Medlink.   They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks.   According to court documents, Duran, Valera and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.

On Aug. 23, 2011, a jury found co-conspirator Judith Negron, the third owner and operator of ATC, guilty of all 24 felony counts charged in the February 2011 superseding indictment.   Co-conspirator Margarita Acevedo, also charged in the February 2011 superseding indictment, pleaded guilty on April 7, 2011, for her role in the fraud scheme.  Today, Judge King sentenced Acevedo to 91 months in prison and three years of supervised release following her prison term.  Avecedo was also sentenced to pay more than $72 million in restitution, jointly and severally with her co-defendants. 

ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud.   ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.  On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million.   Both corporations have been defunct since their owners were arrested in October 2010.

Today’s sentence 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; Special Agent-in-Charge John V. Gillies 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 case was prosecuted by Trial Attorney Jennifer 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 1,140 defendants that collectively have billed the Medicare program for more than $2.9 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go towww.stopmedicarefraud.gov.

JURY CONVICTS MIAMI MAN FOR STEALING IDENTITY INFORMATION FROM DCF COMPUTERS FOR USE IN MEDICARE FRAUD SCAM

JURY CONVICTS MIAMI MAN FOR STEALING IDENTITY INFORMATION FROM DCF COMPUTERS FOR USE IN MEDICARE FRAUD SCAM

September 14, 2011

FOR IMMEDIATE RELEASE

Co-conspirator convicted and sentenced for buying and using stolen DCF patient information to commit Medicare fraud

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Henry Gutierrez, Postal Inspector in Charge, United States Postal Inspection Service, Miami Division, Michael K. Fithen, Special Agent in Charge, U.S. Secret Service, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, Dawn E. Case, Inspector General, Florida Department of Children and Families, and James K. Loftus, Director, Miami-Dade Police Department, announced that a jury returned a verdict of guilty on September 12, 2011 against Yenky Sanchez, 25, of Miami. Sanchez was found guilty on one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349; one count of conspiracy to commit authentication feature fraud, in violation of Title 18, United States Code, Sections 1028(a)(3) and (f); and ten counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A(a)(1). The guilty verdict against Sanchez follows on the heels of the guilty plea by his co-conspirator, Raul Lazaro Diaz-Perera, 43, of Miami, for the same charges.

According to the evidence at trial against Sanchez, and in the factual proffer filed with the court during Diaz-Perera’s plea hearing, Diaz-Perera was a former supervisor at the Florida Department of Children and Families’ call center in downtown Miami. On the day he was fired, October 28, 2010, Diaz-Perera negotiated with a cooperating subject to sell the Medicare numbers of elderly and disabled Floridians who had applied to DCF for food stamps, cash benefits, and Medicaid. The intent was for those numbers to be used to fraudulently bill Medicare for services that were never provided to the DCF beneficiaries. Diaz-Perera obtained the Medicare numbers from the DCF computer system through a contact he had at DCF.

That contact was defendant Yenky Sanchez, who was then working as an employee at DCF’s call center in downtown Miami. Sanchez used his access to the DCF internal computer system to obtain the names, addresses, telephone numbers, dates of birth, Social Security numbers, and Medicare numbers of 148 elderly and disabled Floridians. Sanchez then gave the personal identification information to Diaz-Perera, who sold it to the cooperating subject on December 15, 2010.

Diaz-Perera negotiated a second time with the cooperating subject to sell additional Medicare numbers. Diaz-Perera again turned to Sanchez to obtain the numbers. Sanchez again used his access to the DCF computer system to steal the names and other identification information, including Medicare numbers of more than 400 beneficiaries. Sanchez then gave these additional numbers to Diaz-Perera, who attempted to sell it to the cooperating subject on January 18, 2011.

On June 30, 2011, U.S. District Court Judge Cecilia M. Altonaga sentenced Diaz-Perera to 36 months in prison, to be followed by three years of supervised release. Sentencing for Sanchez is scheduled for November 21, 2011. At sentencing, Sanchez faces a maximum of ten years in prison on the health care fraud charge, five years on the authentication feature fraud charge, and two years each for the aggravated identity theft charges.

This case was investigated by the United States Postal Inspection Service’s Identity Theft and Economic Crimes Task Force, the U.S. Secret Service, the FBI, and the Miami-Dade County Police Department, and prosecuted by Assistant United States Attorneys Robert J. Luck and Adam M. Schwartz. The Office commends the Florida Department of Children and Families for its cooperation in the investigation and prosecution of two of its former employees.

Owner of Miami-Area Mental Health Company Sentenced to 50 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

Owner of Miami-Area Mental Health Company Sentenced to 50 Years in Prison for Orchestrating $205 Million Medicare Fraud Scheme

Longest Prison Sentence Ever Imposed in a Medicare Fraud Strike Force Case

WASHINGTON – Miami resident Lawrence Duran, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 50 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.

Duran, 49, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida.  Judge King ordered Duran to pay more than $87 million in restitution, jointly and severally with his co-defendants.  Duran was also sentenced to three years of supervised release following his prison term.  The sentencing hearing for Marianella Valera, the other owner of ATC, is scheduled for Sept. 19, 2011. 

Two of the corporations that Duran and Valera used to commit the fraud scheme, ATC and Medlink Professional Management Group Inc., were sentenced today to five years of probation per count and ordered to pay restitution of $87 million.  Both corporations have been defunct since their owners were arrested in October 2010.

On April 14, 2011, Duran and Valera pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011.   The superseding indictment charged Duran with 38 felony counts and Valera with 21 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.  Duran and Valera were remanded to the custody of the U.S. Marshals Service after their arrest on Oct.  21, 2010, and have been detained since that time.  Their assets were frozen at the time of their arrests through civil forfeiture proceedings.  ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud.  ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.

“For years, Mr. Duran stole millions of taxpayer dollars by defrauding Medicare and preying upon vulnerable citizens suffering from Alzheimer’s disease, dementia and substance abuse,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division.  “Instead of providing patients with the treatment they needed, Mr. Duran and his co-conspirators used them as props to fill their fraudulent mental health centers.  As a further insult, Mr. Duran created an organization to lobby Congress for additional funds to support the mental health services his fraud scheme purported to provide.  Today’s sentence – the longest ever imposed in a Medicare Fraud Strike Force case - reflects the reprehensibility of the defendant’s conduct, and is a powerful warning sign to others inclined to cheat the Medicare program.”

“For eight years, the defendant billed Medicare for hundreds of millions of dollars in mental health services that were not necessary or never provided,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.  “We will not allow our scar ce Medicare dollars to be diverted from the sick and the elderly into the pockets of greedy fraudsters.”

“Today’s sentencing demonstrates to those who defraud taxpayers of millions of dollars through health care fraud schemes that the FBI and our partners remain committed to investigating and prosecuting such fraud to the fullest extent of the law,” said FBI Miami Division acting Special Agent in Charge Xanthie Mangum.

“Today’s sentencing is therapeutic for Americans fed up with those whose business plan is to steal from taxpayers,” said Christopher Dennis, Special Agent in Charge of the HHS Office of Inspector General’s region that covers Florida.  “Mr. Duran thought he could enrich himself and beat the law.  He will now have years and years behind bars to reflect on that mistake.”    

In pleading guilty, Duran and Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010.  Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported 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.  Duran and Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to court documents, Duran, Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients.  According to court documents, the treatments were medically unnecessary or never provided at all.  Duran and Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash.  The defendants and their co-conspirators used sophisticated measures to conceal their fraudulent activities from Medicare and from law enforcement. 

As part of the fraud scheme, Duran, Valera and others 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.  The defendants and their co-conspirators actively recruited ALF and halfway house owners and operators and patient brokers to participate in the scheme.  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 $205 million in medically unnecessary services.

According to the superseding indictment to which they pleaded guilty, Duran, Valera and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments.  According to court documents, Duran and Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services.  Duran, Valera and co-conspirators caused doctors to refer ATC patients to ASI even though the patients did not qualify for sleep studies. 

According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries.  According to court documents, they used another company they owned and operated, Medlink, to conceal the health care fraud and kickbacks from Medicare and law enforcement.  Once Medicare paid ATC and ASI for the fraudulently billed services, Duran, Valera and others transferred millions of dollars to Medlink.  They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks.  According to court documents, Duran, Valera and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.

On Aug. 23, 2011, a jury found co-conspirator Judith Negron, the third owner and operator of ATC, guilty of all 24 felony counts charged in the February 2011 superseding indictment.  Co-conspirator Margarita Acevedo, also charged in the February 2011 superseding indictment, pleaded guilty on April 7, 2011, for her role in the fraud scheme.

Today’s sentences were announced by Assistant Attorney General Breuer of the Justice Department’s Criminal Division; U.S. Attorney Ferrer of the Southern District of Florida; Special Agent-in-Charge Gillies of the FBI’s Miami Field Office; and Special Agent-in-Charge Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case was prosecuted by Trial Attorney Jennifer 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 1,140 defendants that collectively have billed the Medicare program for more than $2.9 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go towww.stopmedicarefraud.gov. 

Miami Woman is 10th Person Arrested for Her Role in Leading $27 Million Health Care Fraud Conspiracy

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 B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, announced today’s arrest of Elizabet Lombera, 39, of Miami Lakes, Florida. On August 4, 2011, a federal grand jury in Miami indicted Lombera with one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349, six counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and six counts of aggravated identity theft, in violation of Title 18, United States Code, Section 1028A, Case No. 11-20528-Cr-Seitz.

If convicted, the defendant faces a possible maximum statutory sentence of 10 years’ imprisonment on the conspiracy and the health care fraud counts. In addition, each count of aggravated identity theft carries a two-year mandatory minimum term of imprisonment to run consecutive to any other sentence.

According to the indictment, Lombera and her co-conspirators installed nominee presidents to hide her control of five durable medical equipment companies in Miami that submitted fraudulent claims to Medicare, including Mercy Medical Supply, Inc., JHH Group, Inc., La Numero 1 Farmacia Discount Corp., Yani’s Pharmacy, Inc., and El Perimetro Farmacia Discount Corp. Collectively, these five companies submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements. The indictment alleges that Lombera used the proceeds for personal gain, including paying for a trip to Japan.

Six of Lombera’s co-conspirators have already been sentenced for their roles in this conspiracy. Maykel Diaz Escalona, the nominee owner of Mercy Medical Supply, Inc., was sentenced to 37 months’ imprisonment inUnited States v. Maykel Diaz Escalona, Case No. 09-Cr-20084-Graham. Marcelino Avila, the nominee owner of JHH Group, was sentenced to 46 months’ imprisonment, in United States v. Marcelino Avila, Case No. 08-20730-Cr-Seitz. Douglas Reina, the nominee owner of Yani’s Pharmacy, was sentenced to 37 months’ imprisonment in United States v. Douglas Reina, Case No. 08-Cr-20330-Huck. Obel Martinez was sentenced to 36 months’ imprisonment for laundering approximately $620,000 of health care fraud proceeds in United States v. Obel Martinez, Case No. 10-Cr-20546-King. Emilio Bezanilla was sentenced to 30 months’ imprisonment for laundering approximately $195,000 in United States v. Emilio Bezanilla, Case No. 11-Cr-20096-Lenard. Finally, Edisnel Diaz Soler was sentenced to 27 months’ imprisonment for laundering approximately $580,000 of health care fraud proceeds in United States v. Edisnel Diaz Soler, Case No. 10-Cr-20876-Huck.

Four other individuals have been charged. Luis Fuentes, the nominee owner of El Perimetro, was charged in United States v. Luis Fuentes, Case No. 08-Cr-20199-Martinez, but remains a fugitive. Eliezer Lazo, Joel Martinez Hernandez, and Casimiro Martinez have been arrested and charged separately for their roles in laundering the proceeds of the health care fraud and are awaiting trial in United States v. Eliezer Lazo, Case No. 11-20447-Cr-Altonaga; United States v. Joel Martinez Hernandez, Case No. 11-20446-Cr-Moreno; and United States v. Casimiro Martinez, Case No. 11-Cr-20448-Jordan.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. These case are being prosecuted by Assistant U.S. Attorney H. Ron Davidson and Trial Attorney O. Benton Curtis of the Criminal Division’s Fraud Section.

An indictment is only an accusation and a defendant is presumed innocent until and unless proven guilty beyond a reasonable doubt.

Twenty People Indicted in Florida for Health Care Fraud Scheme Involving Approximately $200 Million in Medicare Billing

Twenty People Indicted in Florida for Health Care Fraud Scheme Involving Approximately $200 Million in Medicare Billing

Related Action Charges Four Other Defendants with Additional Offenses

WASHINGTON – Twenty individuals, including three doctors, were charged today in the Southern District of Florida for various health care fraud, kickback and money laundering charges related to their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services, announced the Departments of Justice and Health and Human Services (HHS).
The 38-count indictment unsealed today in U.S. District Court in the Southern District of Florida alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc.  According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all.  The indictment alleges that various defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering patients to ATC facilities.  Various defendants are charged with participating in an extensive and complicated money laundering scheme related to the cash for kickback payments.  Sixteen defendants were arrested this morning in the Southern District of Florida and are expected to appear in U.S. District Court in Miami later today.   Arrests are expected to continue in the coming days.  
ATC’s and Medlink’s owners and managers, Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were originally indicted along with the corporate entities, ATC and Medlink, in October 2010.  A superseding 38-count indictment unsealed today in the Southern District of Florida charges them with additional offenses.

“As today’s charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division.  “The alleged scheme was brazen in scope, and carried out by the company’s owners, doctors, marketers and others.  By exploiting positions of trust, these defendants masked their fraudulent operation as a legitimate mental health business.  These charges are evidence that we will pursue Medicare cheats no matter their position.”

“Community mental health centers are an essential element of the nation’s health care system and serve vulnerable populations,” said Daniel R. Levinson, HHS Inspector General.  “Today’s arrests by OIG agents and our law enforcement partners show that we will not tolerate criminals who pay kickbacks for referrals of Medicare business or who bill for services that were either medically unnecessary or never provided.”

“Community Mental Health Centers can no longer use phantom medical care as a front to bilk Medicare for unnecessary or nonexistent medical services,” said FBI Special Agent in Charge John V. Gillies of the Miami Field Office.   “The FBI and our law enforcement partners will investigate and criminally prosecute such fraud to the fullest extent of the law.”

U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida stated, “Health care fraud has evolved from DME fraud, to infusion fraud, to home health care fraud, and now, as this case shows, to community mental health treatment fraud.  Worse yet, health care fraud has come to permeate every level of the health care industry, from the owners and managers of dirty clinics, to complicit doctors, program directors, therapists, marketers, and patient recruiters.  Today’s prosecution confirms that we are well-equipped and primed to fight the changing face of Medicare fraud in the Southern District of Florida, and that we will prosecute every link in the fraud chain.” 

According to court documents, ATC, headquartered in Miami, operated purported partial hospitalization programs (PHPs) in seven different locations throughout Florida, from Homestead to Orlando.  A PHP is a form of intensive treatment for mental illness.  Court documents allege that Duran and Valera orchestrated the fraud, kickback and money laundering schemes.  Negron assisted Duran and Valera in operating the schemes.  Acevedo operated the kickback scheme.        
According to court documents, doctors Mark Willner, Alan Gumer and Alberta Ayala were medical directors for ATC, and Vanja Abreu (Ph.D.), Nancy Merced-Sola and Lydia Ward (Ph.D.) served as program directors who managed ATC facilities.  Nichole Eckert was a therapist at ATC.  Court documents allege that Duran, Negron and Valera, along with the program directors and Eckert, regularly altered and instructed others to alter patient charts and notes from therapy sessions at ATC in order to make it appear that the patients being treated qualified for PHP treatments, when, in fact, they did not.  According to the indictment, Willner, Gumer and Ayala then signed the false patient charts authorizing unnecessary treatment or continued treatment for patients who were not eligible for PHP treatment, without examining the patients or the charts.  Duran and Valera also allegedly instructed employees and doctors at ATC, including Willner, Gumer and Ayala, to alter diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments.
According to court documents, Valera, Willner, Gumer and Ayala manipulated the length of patients’ stays in order to maximize the number of days Medicare would pay for the PHP services.  According to a civil complaint filed in the Southern District of Florida, ATC routinely admitted patients to the PHP program who suffered from Alzheimer’s and severe dementia and therefore were not eligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.
The indictment also alleges that Sandra Jimenez, Hilario Morris and Joseph Valdes were marketers for ATC and participated in the kickback operation.  These marketers, along with Duran, Valera, Negron and Acevedo, allegedly paid kickbacks to patient brokers and owners and operators of ALFs and halfway houses in exchange for delivering patients from their facilities to ATC.  The indictment alleges that defendants Mathis Moore, Nelson Fernandez, Leyanes Placeres, James Edwards, Frank Criado and Curtis Gates were patient brokers and, in exchange for kickbacks, provided patients to ATC every month from ALFs and halfway houses with which they had relationships.  The indictment alleges that the kickback payments totaled millions of dollars.
The indictments allege that the kickback scheme was supported by a money laundering scheme whereby individuals received checks in their own names or in the names of shell corporations they created, cashed the checks and returned the cash to Duran and Valera, which Duran and Valera then used to pay the kickbacks.  Defendants Adriana Mejia, Pedro Sosa, Yoisel Cancio and an unnamed coconspirator, along with Moore, Fernandez, Placeres, Edwards, Criado and Gates, allegedly participated with Duran, Valera, Negron and Acevedo in the charged money laundering conspiracy.  According to the indictment, Mejia, Sosa and Cancio received monthly, bi-weekly and weekly payments from Medlink despite the fact that they had no job functions at Medlink or ATC, other than laundering money.  The indictments also charge that Duran, Valera, Negron, Mejia, Sosa and Cancio engaged in transactions designed to conceal proceeds of unlawful activity and structured their transactions to avoid reporting requirements that require banks to report certain transactions.  According to the indictments, these defendants together laundered millions of dollars over several years.
The alleged scheme also involved a company called American Sleep Institute (ASI), which purportedly provided sleep study services.  The defendants paid additional kickbacks for some patients to also visit ASI.  Court documents allege that Willner, Gumer and Ayala furthered the health care fraud conspiracy by referring patients to ASI.
In a separate action in October 2010, a civil complaint for injunctive relief was filed in U.S. District Court in the Southern District of Florida and a preliminary injunction was obtained to freeze the assets of Duran, Valera, Negron, Acevedo, ATC and Medlink as well as ASI and D&V Development Inc., as participants in the health care fraud.  Civil court documents allege that D&V Development was owned and operated by Valera and Duran and was established in an effort to divert funds received by ATC and ASI.
An indictment is merely a charge and defendants are presumed innocent until proven guilty.
Today’s actions were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer for the Southern District of Florida; Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office; and Daniel R. Levinson, Inspector General of HHS.
The criminal cases are being prosecuted by Trial Attorneys Jennifer L. Saulino, Maria Gonzalez Calvet and Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.  The related civil action is being prosecuted by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida. The cases are being investigated by the FBI and HHS Office of Inspector General (OIG). The cases were 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 their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for approximately $2.1 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.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov .