Twenty-Four Arrested for Defrauding Medicare of More Than $100 Million

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Lanny A. Breuer, Assistant Attorney General of the Criminal Division; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI); and Christopher Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigation, announce today’s arrest of 24 individuals in South Florida for their participation in a series of separate schemes to defraud Medicare. The arrests in South Florida were part of a nationwide takedown by the Medicare Fraud Strike Force operations that led to charges against 94 defendants for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program.

The South Florida schemes involved a total of more than $100 million in fraudulent claims submitted to Medicare. The defendants include owners and operators of companies, doctors, nurses, and patient recruiters, as well as a medical biller who is alleged to have billed approximately $50 million for fraudulent services. In Miami, the investigations were conducted jointly by the FBI and HHS-OIG, under the auspices of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Florida and the Criminal Division’s Fraud Section.

The Strike Force operations in Miami, Baton Rouge, Brooklyn, Detroit and Houston 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. The HEAT taskforce, co-chaired by Acting Deputy Attorney General Gary Grindler and Deputy Secretary Bill Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars. In December 2009, Strike Force operations were expanded to Brooklyn, Baton Rouge, and Tampa.

Since its inception in March 2007 with Phase One in South Florida and continuing through its most recent expansion into Tampa, Fla., the Strike Force has obtained indictments of more than 720 individuals and organizations that collectively have billed the Medicare program for more than $1.6 billion. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is 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.

U.S. Attorney Wifredo Ferrer stated, “Health care fraud has reached epidemic proportions in South Florida. The cases announced today provide a shocking snapshot of the spectrum of health care fraud in our community, ranging from DME fraud, to infusion fraud, to home health care fraud, to money laundering. We stand united with our partners at FBI and HHS-OIG in our commitment to help stomp out this rampant fraud.”

“The Medicare Fraud Strike Force simply will not allow individuals to pillage the Medicare system and line their pockets at taxpayers’ expense,” said Assistant Attorney General Lanny Breuer. “The charges announced today send a strong message that we will continue to use aggressive and innovative techniques to root out health care fraud and bring would-be fraudsters to justice.”

“South Florida bears the title of ground zero for health care fraud. Although the FBI and its partners devote vast resources to address the issue, prevention by way of regulatory reform is the key to reducing the amount of fraud,” said Special Agent in Charge John V. Gillies of the FBI Miami Division. “But our message to those who commit health care fraud and steal from U.S. taxpayers is clear: you will be caught and you will be punished.”

“Today’s Strike Force actions confirm that the HEAT initiative is reaping important results in combating health care fraud,” said Christopher Dennis, HHS-OIG Special Agent in Charge of the Miami Region. “As the federal government’s health care fraud experts, OIG today has 63 agents working in Miami, along with our law enforcement partners and federal prosecutors. Together, we form a powerful team that responds quickly and forcefully to suspected fraud.”

Today, the HEAT Strike Force arrested the following individuals in South Florida:

U.S. v. Marquez

Jeffery Marquez was charged with conspiracy to commit health care fraud for submitting approximately $50 million in fraudulent claims to Medicare in connection with six HIV-infusion clinics.

U.S. v. Oliva et al.

Five individuals were charged with conspiracy to commit health care fraud, health care fraud, and false claims upon the United States in connection with an approximately $23 million scheme to defraud the Medicare program by submitting fraudulent claims for HIV-infusion services.

U.S. v. Dieppa et al.

Ten individuals, including a doctor, six nurses, two patient recruiters, and a Medicare beneficiary, were charged with conspiracy to commit health care fraud, soliciting and receiving health care kickbacks, and making false statements in connection with an approximately $18 million scheme to defraud the Medicare program by submitting fraudulent claims for home health care services.

U.S. v. Pascual

Ricardo Pascual was charged with health care fraud and money laundering in connection with an approximately $2.6 million scheme to defraud the Medicare program by submitting fraudulent claims for durable medical equipment (DME) as the owner of DME Enterprise Group Inc.

U.S. v. Jimenez

Braidor Jimenez was charged with health care fraud and money laundering in connection with an approximately $2.5 million scheme to defraud the medicare program by submitting fraudulent claims for DME as owner of ELG Enterprises Corp.

U.S. v. Del Risco

Mario Alberto Del Risco was charged with health care fraud in connection with an approximately $670,000 scheme to defraud the Medicare program by submitting fraudulent claims for DME as owner of Del Risco Medical Services Corp.

U.S. v. Martinez

Yoel Perez Martinez was charged with health care fraud in connection with an approximately $541,007 scheme to defraud the Medicare program by submitting fraudulent claims for DME as president of Health Life Plus Corp.

U.S. v. Arrechavaleta and Zaragoza

Eduardo Arrechavaleta and Bernardo Zaragoza were charged with conspiracy to commit money laundering, money laundering, and structuring cash transactions to avoid reporting requirements, in connection with the laundering and withdrawal of health care proceeds from PMCME, Inc., a company that allegedly engaged in an approximately $3.3 million scheme to defraud the Medicare program by submitting fraudulent claims for DME.

U.S. v. Leon

Vivian Leon was charged with conspiracy to commit health care fraud, health care fraud, and making false statements relating to health care matters in connection with a scheme to defraud the Medicare program by submitting fraudulent claims for skilled nursing and home health services by A.H.H. Inc.

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

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.