Fifteen Miami-Area Residents, Including Doctors and Nurses, Charged in $40.8 Million Home Health Care Fraud Scheme
Another Four Miami-Area Residents Charged in $5.8 HIV Infusion Fraud Scheme
|U.S. Attorney’s Office December 15, 2009|
Fifteen Miami-Dade County, Fla., residents have been indicted in connection with an alleged $40.8 million Medicare fraud scheme involving home health care services, while in a separate case, three Miami-Dade County residents and one Broward County, Fla., resident have been indicted in connection with an alleged $5.8 million Medicare fraud scheme involving an HIV infusion clinic, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Criminal Division; Christopher B. Dennis, Special Agent in Charge of the Department of Health and Human Services Office of the Inspector General (HHS-OIG) - Miami Region; and John V. Gillies, Special Agent in Charge for the FBI’s Miami Field Office, announced today.
Also today, the Departments of Justice and HHS announced the expansion of Medicare Fraud Strike Force operations to Brooklyn, New York; Tampa, Florida; and Baton Rouge, Louisiana. The Medicare Fraud Strike Force has been operating in South Florida since March 2007, and currently also operates in Los Angeles, Detroit, and Houston. The expansion was announced by Secretary Kathleen Sebelius of HHS and Assistant Attorney General Lanny A. Breuer of the Criminal Division.
In the home health care case, Dr. Fred Dweck, M.D.; Arturo Fonseca; Yudel Cayro; Isis Torres, R.N.; Franciso Portillo, R.N.; Armando Sanchez, R.N.; Lissbet Diaz; Marlenys Fernandez; Sheillah Rotta, R.N.; Alain Fernandez; Eduardo Romero; Antonio Ochoa; Teresita Leal, R.N.; Silvio Ruiz, R.N.; and William Madrigal were indicted by a grand jury in Miami on Dec. 10, 2009, for conspiracy to commit health care fraud.
According to the indictment, Dr. Dweck referred approximately 1,279 Medicare beneficiaries for expensive home health and therapy services, as a result of which Medicare was billed approximately $40,888,474 for home health services purportedly provided to these beneficiaries. The indictment alleges that Fonseca and Cayro operated Courtesy Medical Group Inc. (Courtesy Medical), a purported medical clinic in Miami, where Dr. Dweck worked. According to the indictment, approximately 344 of the Medicare beneficiaries Dr. Dweck referred for home health services were referred through Courtesy, as a result of which Medicare was billed approximately $16,605,878 for home health services purportedly provided to these beneficiaries. The indictment alleges that Fonseca and Cayro solicited and accepted kickbacks and bribes in return for having Dr. Dweck sign prescriptions for therapy and home health services, medical certifications and home health plans of care.
The indictment also alleges that Romero and Ochoa received kickbacks and bribes for recruiting Medicare beneficiaries to receive home health services through Dr. Dweck and Courtesy Medical. In addition, the indictment alleges that nurses and home health aides Torres, Portillo, Sanchez, Diaz, Marlenys Fernandez, Rotta, Alain Fernandez, Romero, Ochoa, Leal, and Ruiz falsified patient files to make it appear that the Medicare beneficiaries qualified for the home health services being billed to Medicare, when in fact they did not. Finally, the indictment alleges that Madrigal solicited and accepted kickbacks and bribes for allowing his Medicare number to be used to bill Medicare for unnecessary home health treatments.
In addition to the conspiracy count, the indictment includes the following charges:
- Dweck, Torres, Portillo, Sanchez, Diaz, Marlenys Fernandez, Rotta, Alain Fernandez, Ruiz and Leal were charged with one count of making false statements for use in determining rights to benefits or payments under Medicare;
- Fonseca was charged with five counts of receiving kickbacks in return for referring an individual for or arranging for the furnishing of items and services payable by Medicare;
- Romero was charged with four counts of receiving kickbacks in return for referring an individual for or arranging for the furnishing of items and services payable by Medicare;
- Achoa was charged with three counts of receiving kickbacks in return for referring an individual for or arranging for the furnishing of items and services payable by Medicare, and;
- William Madrigal was also charged with one count of receiving kickbacks.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of ten years. Each count of soliciting and receiving health care kickbacks carries a maximum prison sentence of five years and each count of making false statements carries a maximum prison sentence of five years
“Fraud—whether in the area of DME, infusion care or home health care services—is a multi-million drain on our limited Medicare trust fund,” said Acting U.S. Attorney Jeffrey H. Sloman. “The Southern District of Florida will continue to aggressively prosecute these cases, with the dual goals of seizing and returning stolen Medicare dollars when possible and deterring criminals from continuing to use Medicare as their private piggy bank.”
John V. Gillies, Special Agent in Charge for the FBI’s Miami Field Office, stated, “It is appalling how much money is wasted on fraud in the health care industry, money that could be used to treat someone who truly needs the services. It is also disheartening when so many individuals in the medical care system, from doctors and nurses down to beneficiaries, participate in these schemes. The FBI and our law enforcement partners will continue to aggressively investigate these alleged fraud schemes and the medical care professionals who abuse their positions of trust for personal gain.”
“The HEAT operation today in Miami demonstrates the continued success of our interagency South Florida Strike Force team and is clear evidence of our resolve to investigate and stop schemes that abuse federal health care programs at the expense of taxpayers and vulnerable recipients,” said Christopher B. Dennis, Special Agent in Charge of the HHS-OIG Miami Region.
In a separate indictment unsealed on Dec. 14, 2009, four defendants were charged with conspiracy to commit Medicare fraud through Tendercare Medical Center Inc. (Tendercare), a purported Miami-area HIV infusion clinic. The defendants in that case are David Marrero, Maria Volero Marrero, Keith Ernest Humes, and Lawrence Edward Humes.
According to the indictment, David Marrero and Maria Volero Marrero created, owned and/or operated Tendercare, a medical clinic that purported to provide injection and infusion treatments to HIV/AIDS patients, and that submitted claims Medicare for such services. The indictment alleges that the scheme resulted in billings to Medicare of approximately $5,836,794 for purported injection and infusion treatments. Also according to the indictment, Keith Ernest Humes and Lawrence Edward Humes acted as patient recruiters for Tendercare, offering and paying kickbacks and bribes to Medicare beneficiaries so that the beneficiaries would allow their Medicare numbers to be used to bill the Medicare program for expensive, unnecessary HIV infusion treatments.
The four individuals were indicted by a grand jury in Miami on Dec. 10, 2009, for conspiracy to commit health care fraud. In addition to the conspiracy count, David Marrero was also charged with four counts of health care fraud, one count of conspiracy to commit money laundering and one count of money laundering; Maria Volero Marrero was also charged with four counts of health care fraud, one count of conspiracy to commit money laundering, and seven counts of money laundering.
The charges of conspiracy to commit health care fraud and conspiracy to commit money laundering each carry a maximum prison sentence of 10 years. In addition, each count of committing health care fraud and each count of money laundering carries a maximum prison sentence of 10 years.
An indictment is merely a charge and defendants are presumed innocent until proven guilty.
The cases are being prosecuted by Trial Attorneys N. Nathan Dimock, Martha Talley, Michael Padula and Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the Department of Health and Human Services (HHS), Office of Inspector General.
The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and Acting U.S. Attorney Sloman of the Southern District of Florida. Since the inception of Strike Force operations in March 2007—Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), Houston (Phase Four), and Brooklyn (Phase Five)—the Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than one billion dollars.
The joint DOJ-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. In May 2009, the Department of Justice and HHS announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort to focus joint efforts to prevent fraud and enforce current anti-fraud laws around the country. As part of the HEAT initiative, Medicare Fraud Strike Force operations were expanded from South Florida and Los Angeles to Detroit and Houston, and now to Brooklyn, Tampa and Baton Rouge.
To learn more about the HEAT initiative, go to: www.hhs.gov/stopmedicarefraud.
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 www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the United States District Court for the Southern District of Florida at www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov.