Twenty-Four South Florida Residents Charged as Part of Nationwide Coordinated Takedown by Medicare Fraud Strike Force Operations
Eighty-Nine Individuals Charged Nationally for Submitting Approximately $223 Million in Fraudulent Billing; South Florida Responsible for More Than $45,299,935 in False Billings

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); Ronald Verrochio, Inspector in Charge, U.S. Postal Inspection Service (USPIS), Miami Field Office; and Michael J. DePalma, Acting Special in Charge, Internal Revenue Service, Criminal Investigation (IRS-CI), announced that 24 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare out of more than $45,299,935 million. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in eight cities that resulted in charges against 89 individuals, including doctors, nurses, and other licensed professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings.

U.S. Attorney Wifredo Ferrer stated, “Health care fraud continues to be a drain on scarce Medicare dollars, as unscrupulous individuals insist on using the Medicare Trust Fund as their private ATMs. We are undaunted and remain committed in our resolve to help preserve and protect Medicare for those who need it—the sick, the elderly, and the poor.”

“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Holder. “These significant actions build on the remarkable progress that the HEAT has enabled us to make—alongside key federal, state, and local partners—in identifying and shutting down fraud schemes. They are helping to deter would-be criminals from engaging in fraudulent activities in the first place. And they underscore our ongoing commitment to protecting the American people from all forms of health care fraud, safeguarding taxpayer resources, and ensuring the integrity of essential health care programs.”

“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” said Secretary Sebelius. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: You will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee.”

“Today’s Medicare Fraud Strike Force takedown reminds us that South Florida remains ground zero for health care fraud. Almost one third of those charged in this eight-city operation were from the Miami area, accounting for more than $45 million in fraud,” said Michael B. Steinbach, Special Agent in Charge of FBI Miami Division. “Health care fraud is a multi-billion-dollar crime problem that is not going away. The FBI is committed to rooting out health care fraud and reclaiming money that was dishonestly obtained.”

“Taxpayers expect us to work harder and smarter, and that is exactly what happened here today,” said Christopher B. Dennis, Special Agent in Charge, Office of Inspector General, U.S. Department of Health and Human Services, Miami region. “With the coordinated work of my agents and other law enforcement officials, we will not cease aggressive investigation and prosecution of those who exploit taxpayers and federal health programs. Today’s arrests clearly demonstrate our joint commitment with all our law enforcement partners to identify and rapidly address health care fraud.”

Michael J. DePalma, Acting Special in Charge for IRS-CI stated, “It is disappointing that these defendants opted for what many think is fast and easy money. But health care fraud is not a victimless crime. Health care fraud affects each of us, as tax dollars are stolen and squandered. IRS-CI will continue to lend its financial investigative expertise to ensure that fraudsters are not allowed to enjoy their ill-gotten gains. Together with our law enforcement partners, we will continue to aggressively investigate health care fraud in South Florida.”

“This is what these operations are all about: coordinated takedowns such as this are at the heart of our strike force efforts to stop the illegal schemes that hurt victims in our communities and our government,” said USPIS Inspector in Charge Ronald Verrochio.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and 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 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 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.

Specifically, the South Florida cases announced as part of the nationwide Medicare Fraud Strike Force takedown include:

U.S. v. Emilio Amador, Cristobal Gonzalez, Eduims Mora, Jose Contreras, and Elizabeth Monteagudo, Case No. 13-20315-CR-Lenard

Five defendants are charged with conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks in connection with a federal health care program. According to the indictment, the defendants participated in a scheme involving Caring Nurse Home Health Corp. and Good Quality Home Health Inc. The defendants allegedly supplied patients to Caring Nurse and/or Good Quality in exchange for kickbacks and bribes. Caring Nurse and Good Quality, in turn, fraudulently billed Medicare for approximately $50 million for home health services that were not provided and/or were not medically necessary. If convicted, the defendants face up to five years for each count. This case is being prosecuted by Trial Attorney Joseph Beemsterboer of the Criminal Division’s Fraud Section.

United States v. Rafael Meana and Janet Farigola, Case No. 13-20275-CR-Middlebrooks

Defendants Rafael Meana and Janet Farigola are charged with conspiracy to commit health care fraud and several substantive counts of health care fraud. According to the indictment, the defendants participated in a scheme involving Lord’s Medical & Rehab Center Inc. (Lord’s), a medical clinic that purportedly provided Medicare Advantage beneficiaries with medical items and services. From February 2010 through July 2011, Meana and Farigola allegedly caused Lord’s to submit approximately $5,497,047 in Medicare claims falsely claiming that health care benefits and services were medically necessary and had been provided to Medicare beneficiaries. As a result of the submission of these claims, Medicare paid Lord’s approximately $2,240,134. If convicted, the defendants face up to 10 years in prison for each count of health care fraud. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

United States v. Jose Moran, Rafael Meana, and Armando Rubio Cordero, Case No. 13-20274-CR-Graham

The defendants are charged with conspiracy to commit health care fraud and several substantive counts of health care fraud. According to the indictment, the defendants participated in a scheme involving Lord Family Services Inc., a medical clinic that purportedly provided Medicare Advantage beneficiaries with medical items and services. From January 2010 through September 2011, the defendants allegedly caused Lord Family Services Inc. to submit approximately $1,919,751 in Medicare claims falsely claiming that health care benefits and services were medically necessary and had been provided to Medicare beneficiaries. As a result of the submission of these claims, Medicare paid Lord Family Services Inc. approximately $976,476. If convicted, the defendants face up to 10 years in prison for each count of health care fraud. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

United States v. Karina Merino, Case No. 13-20332-CR-Martinez

Defendant Karina U. Merino is charged with a single count of health care fraud in connection with her role in a massive health care fraud scheme involving Ideal Home Health Inc. (Ideal), which submitted more than $40 million in fraudulent claims to Medicare. The information alleges that Merino, as a nurse for Ideal, falsified patient visitation logs to reflect that home health care nursing services had been provided to beneficiaries when such services had, in fact, not been provided. Ideal fraudulently billed the Medicare program for approximately $148,000. If convicted of the health care fraud charge, Merino faces up to 10 years in prison. This case is being prosecuted by Assistant U.S. Attorney Kevin J. Larsen.

United States v. Delia Y. Chaveco and Arturo Y. Chaveco, Case No. 13-20333-CR-Moore

Delia Y. Chaveco and Arturo Y. Chaveco (the Chavecos) were charged by Information with a single count of conspiracy to receive kickbacks in connection with a federal health care benefit program. This charge stems from the Chavecos’ role in a health care fraud scheme involving Ideal Home Health Inc. (Ideal), an agency that submitted more than $40 million in fraudulent claims to the Medicare program. The Information alleges that Ideal and other Miami-Dade area home health agencies paid the Chavecos kickbacks in exchange for recruiting Medicare beneficiaries that they later used to bill the Medicare program. If convicted, the defendants face up to five years in prison. This case is being prosecuted by Assistant U.S. Attorney Kevin J. Larsen.

United States v. Roberto Marrero, Sandra Fernandez Viera and Enrique Rodriguez, Case No. 13-20318-CR-Moore

In this case, the defendants are charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, and substantive kickback charges. Defendants Roberto Marrero and Sandra Fernandez Viera were the owners and operators of Trust Care Health Services Inc. (Trust Care), which allegedly paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries and then submitted more than $20 million in false and fraudulent claims to Medicare, primarily for skilled nursing diabetic care and physical/occupational therapy. Defendant Enrique Rodriguez worked as a patient recruiter for Trust Care, supplying patients in exchange for kickbacks and bribes. A civil injunction is being filed under 18 U.S.C. § 1345 to restrain the defendants’ assets to satisfy restitution in the criminal matter. If convicted, the defendants face up to 10 years for the health care fraud charges and five years for each count of the kickback charges. This case is being prosecuted by Trial Attorney Brendan Stewart of the Criminal Division’s Fraud Section and the civil injunction is being handled by Civil Health Care Fraud Coordinator Assistant U.S. States Attorney Mark Lavine.

United States v. Dora Moreira, Ivan Alejo, and Hugo Morales, Case No. 13-20298-CR-Martinez

In this case, the defendants are charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, substantive kickback charges, conspiracy to commit money laundering, and substantive money laundering. Defendant Dora Moreira was the owner and operator of Anna Nursing Services Corp. (Anna Nursing), which paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries. Anna Nursing was paid more than $7 million for the false claims it submitted to Medicare, which claims were primarily for physical/occupational therapy. Defendant Ivan Alejo worked at Anna Nursing and was responsible for, among other things, negotiating kickback rates and distributing kickback payments to patient recruiters on behalf of Anna Nursing. Defendant Hugo Morales worked as a physical therapist on behalf of Anna Nursing and was responsible for, among other things, fabricating patient medical documentation. Defendant Dora Moreira laundered money for the purpose, among others, of concealing the proceeds of the fraud and the payment of kickbacks to recruiters. The Asset Forfeiture Section has obtained restraining orders on the corporate bank account and on real property that is traceable to the fraud. If convicted, the defendants face up to 10 years for the health care fraud charges, five years for each count of the kickback charges, and 20 years for the money laundering charges. This case is being prosecuted by Trial Attorney Brendan Stewart of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Eloisa Fernandez of the Asset Forfeiture Section.

United States v. Marina Sanchez Pajon and Miguel Jimenez, Case No. 13-20299-CR-Ungaro

Defendants are charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, and substantive kickback charges. Defendants Marina Sanchez Pajon and Miguel Jimenez were the owners and operators of Flores Home Health Care Inc. (Flores Home Health), which allegedly paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries. Flores Home Health was paid more than $8 million for the false claims it submitted to Medicare, which claims were primarily for physical/occupational therapy. The Asset Forfeiture Section has obtained seizure warrants and restraining orders on five vehicles and bank accounts containing $160,000. They have also filed lis pendens against four real properties that were purchased with proceeds of the fraud. If convicted, the defendants face up to 10 years for the health care fraud charges and five years for each count of the kickback charges. This case is being prosecuted by Trial Attorney Brendan Stewart of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Timothy Abraham of the Asset Forfeiture Section.

United States v. Miguel A. Rodriguez, Case No. 13-20319-CR-Lenard

Defendant Miguel A. Rodriguez is charged with three counts of paying kickbacks in connection with a federal health care program. The defendant allegedly paid kickbacks and bribes to induce medical providers to refer Medicare beneficiaries to his medical company for services, including x-rays. If convicted, the defendant faces up to five years in prison for each count of the kickback charges. This case is being prosecuted by Assistant U.S. Attorney John Gonsoulin.

United States v. Enrique Alberto Siret Rodriguez, Case No. 13-20284-CR-Moore

Defendant Enrique Alberto Siret Rodriguez is charged with four counts of health care fraud and two counts of paying kickbacks in connection with a federal health care program. The defendant allegedly paid kickbacks and bribes to a doctor for fraudulent home health care prescriptions that could be used to fraudulently bill Medicare. If convicted, the defendant faces up to 10 years in prison for each health care fraud count and up to five years for each of the kickback counts. This case is being prosecuted by Assistant U.S. Attorney John Gonsoulin.

United States v. Alberto Cosme Garcia, Case No. 13-20283-CR-Ungaro

Defendant Alberto Cosme Garcia is charged with one count of health care fraud and two counts of paying kickbacks in connection with a federal health care program. The defendant allegedly paid kickbacks and bribes to a doctor for fraudulent home health care prescriptions that could be used to fraudulently bill Medicare. If convicted, the defendant faces up to 10 years in prison for the health care fraud count and up to five years for each of the kickback counts. This case is being prosecuted by Assistant U.S. Attorney John Gonsoulin.

Mr. Ferrer commended the investigative efforts of the FBI, HHS-OIG, USPIS and IRS-CI.

An indictment and Information are merely charges, 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.