Operator of Miami HIV Clinic Pleads Guilty to Role in Medicare Fraud Ring
Defendant was Fugitive Since 2008

WASHINGTON—Jose Garcia, 55, who was a fugitive for nearly two years, pleaded guilty today in U.S. District Court in Miami to his participation in a Medicare fraud scheme involving a Miami-area HIV clinic, the Departments of Justice and Health and Human Services (HHS) announced. Garcia was indicted in 2008 and self-surrendered to FBI agents in May 2010.

Garcia pleaded guilty before U.S. District Judge Adalberto Jordan to one count of conspiracy to cause the submission of false claims to the Medicare program and to pay health care kickbacks; and one count of conspiracy to commit health care fraud. At sentencing, scheduled for Nov. 18, 2010, Garcia faces a maximum penalty of five years in prison for the false claims and kickback conspiracy count and a maximum penalty of 10 years in prison for the health care fraud conspiracy count.

According to court documents, Garcia operated Global Med-Care Corp. Inc., a medical clinic in Miami that purported to specialize in treating patients with HIV. Garcia, his co-defendant Nayda Freire and their co-conspirators caused Global to submit claims to the Medicare program for expensive HIV medication that was medically unnecessary or never provided. In return for a share of Global’s profits, Garcia and Freire agreed with their co-conspirators to oversee the staff necessary to operate Global, the Medicare patients whom Global billed to the Medicare program and the transportation for the patients. Garcia admitted that he knew that Global would need to pay kickbacks to its patients and that Global could bill Medicare for HIV infusion services three times a week, for up to three months, for each patient. Garcia also admitted that from approximately April 2003 through approximately August 2003, Global submitted approximately $10.9 million in claims to the Medicare program for HIV infusion services that were never provided and/or medically unnecessary.

Freire pleaded guilty on Aug. 28, 2008, to one count of conspiracy to defraud the Medicare program, and was sentenced by Judge Jordan on Nov. 12, 2008, to 30 months in prison. Freire was also sentenced to two years of supervised release following her prison term and ordered to pay $7.9 million in restitution to the Medicare program.

Freire admitted that after payments from Medicare were made into the bank accounts of Global Med-Care, she and others transferred approximately $6 million of the fraud proceeds to sham management, marketing and investment companies owned and operated by co-conspirators Carlos, Luis and Jose Benitez. Co-conspirators Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, these co-conspirators allegedly provided the money and staff necessary to open Global Med-Care; the Medicare patients whom the clinic would bill to the Medicare program; and transportation for the HIV patients who visited the clinic. That indictment also alleges that Carlos and Luis Benitez were the true owners of Global Med-Care.

The three Benitez brothers and McKenzie were charged with participating in the commission of approximately $109 million in HIV infusion fraud and money laundering through Global Med-Care and 10 other HIV infusion clinics. On Sept. 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program, and also admitted his role in a $119 million HIV infusion fraud scheme. McKenzie was sentenced by U.S. District Judge Alan S. Gold on Dec. 18, 2008, to 14 years in prison in connection with his role in the HIV infusion Medicare fraud scheme. In addition to the prison sentence, McKenzie was ordered to serve three years of supervised release following his prison term and pay $84 million in restitution to the Medicare program. The Benitez brothers remain fugitives.

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

The Global case was prosecuted by Deputy Chief Hank Bond Walther and Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section, and investigated by the FBI and HHS Office of Inspector General (HHS-OIG). The case 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 seven districts have obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 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.