Pharmacy Owner Pleads Guilty in Miami for Role in $23 Million Health Care Fraud Scheme

WASHINGTON—A co-owner and operator of three Miami discount pharmacies pleaded guilty today in connection with a $23 million health care fraud scheme, announced 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; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.

Jose Carlos Morales, 55, of Miami, pleaded guilty today before U.S. District Judge Joan A. Lenard in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks.

According to court documents, Morales was the co-owner of Pharmovisa Inc., which operated two pharmacies in Miami, and PharmovisaMD Inc., which operated one pharmacy in Miami. Morales pleaded guilty to agreeing to pay illegal health care kickbacks to co-conspirators in return for a stream of beneficiary information to be used to submit claims to Medicare and Medicaid. The beneficiaries who were referred to Pharmovisa and PharmovisaMD (Morales pharmacies) in exchange for kickbacks payments resided at assisted living facilities (ALFs) located in Miami. Morales and his alleged co-conspirators also paid illegal health care kickbacks to physicians in exchange for prescription referrals, which the Morales pharmacies ultimately billed to Medicare.

Court documents also reveal that beginning in approximately 2007, at Morales’ direction, drivers working for Morales pharmacies delivered “bingo cards” containing pop out medications to ALFs located throughout the Southern District of Florida, and Morales instructed these drivers to pick up any unused “bingo cards” so that Morales pharmacy personnel could place these medications back into pill bottles. Unused and partially used medications were eventually re-billed to Medicare and Medicaid, and a majority of the previously submitted claims to Medicare and Medicaid were never reversed. Morales also instructed Morales pharmacy personnel to place unused and partially used medications into bottles to be sold directly to the general public from the “community” pharmacy shelves.

In furtherance of the conspiracies, according to court documents, Morales and his alleged co-conspirators also engaged in sham financial transactions to facilitate and conceal the fraud schemes and the flow of fraud proceeds. In most instances, the sham transactions involved shell entities owned and/or controlled by Morales or his alleged co-conspirators.

On October 16, 2012, Esperanza Navailles, a former “marketer” for the Morales pharmacies, pleaded guilty to conspiracy to defraud the United States and pay illegal health care kickbacks. From February 2011 to January 2012, Navailles, on behalf of the Morales pharmacies, paid ALF owners and operators $30 per patient per month for each Medicare beneficiary they referred to the pharmacies. The Morales pharmacies then submitted claims to Medicare for items and services on behalf of the referred Medicare beneficiaries. Navailles admitted that she knew the kickback payments were illegal.

According to court documents, Morales and his co-conspirators submitted and caused to be submitted approximately $23,367,755 in false and fraudulent claims to the Medicare and Florida Medicaid programs.

The cases are being prosecuted by Trial Attorney Allan J. Medina and Special Trial Attorney William Parente of the Criminal Division’s Fraud Section. This 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, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with 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.