45 Individuals and One Corporation Charged as Part of Nationwide Operation by Health Care Fraud Prevention and Enforcement Action Teams (HEAT)
91 Defendants Charged Nationally for Submitting More than $295 Million in Fraudulent Billing
|U.S. Attorney’s Office September 07, 2011|
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 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 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, 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 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.