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November 13, 2015

Miami-Area Pharmacy Owner Sentenced to 42 Months in Prison for Role in $1.5 Million Medicare Part D Fraud Scheme

WASHINGTON—A Miami-area pharmacy owner was sentenced today to 42 months in prison for her role in the submission of more than $1.5 million in fraudulent claims to Medicare Part D.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Tamara Esponda, 48, of Miami, pleaded guilty to one count of health care fraud on Aug. 7, 2015. In addition to imposing the prison sentence, U.S. District Judge James I. Cohn of the Southern District of Florida ordered Esponda to pay $1,583,976 in restitution.

Esponda owned Biomax Pharmacy Inc. According to admissions made in connection with Esponda’s guilty plea, between October 2012 and September 2013, Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs that were not prescribed by physicians, not medically necessary and not provided to Medicare beneficiaries. Esponda further admitted that in perpetrating this fraud she and her accomplices used the beneficiaries’ and doctors’ Medicare identification numbers without their consent. During the course of the scheme, Biomax received more than $1.5 million in payments from Medicare Part D, the prescription drug benefit, based on those false claims.

The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida. The case was prosecuted by Trial Attorney Timothy P. Loper of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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