Former Operator of NYC Health Clinics Pleads Guilty in Manhattan Federal Court in $12 Million Medicare Fraud Scheme
Preet Bharara, the United States Attorney for the Southern District of New York, Scott Lampert, Special Agent-in-Charge of the New York Regional Office of the United States Department of Health and Human Services Office of Inspector General (“HHS-OIG”), Thomas E. Bishop, the Acting Special Agent-in-Charge of the New York Office of the Internal Revenue Service, Criminal Investigation (“IRS-CI”), and George Venizelos, the Assistant Director-in-Charge of the New York Field Office of the Federal Bureau of Investigation (“FBI”), announced that JORGE JUVIER pled guilty today in Manhattan federal court to participating in a scheme to defraud Medicare out of more than $12 million through the use of fraudulent HIV/AIDS clinics in New York City. As part of the Medicare fraud scheme, JUVIER and his co-conspirators billed Medicare for medications that were never administered, that were administered at incorrect dosages or that were medically unnecessary. JUVIER pled guilty today before U.S. Magistrate Judge Frank Maas.
Manhattan U.S. Attorney Preet Bharara said: “With today’s plea, Jorge Juvier has admitted his role in a scheme to set up and operate health care fraud mills where he and his co-conspirators billed Medicare for medications for HIV/AIDS patients that were never correctly provided, and recruited patients to undergo treatments that were largely unnecessary—all so Juvier and his co-conspirators could bilk a federal health care program out of more than $12 million.”
According to the criminal complaint, the information, and other documents filed in Manhattan federal court, as well as statements made at related court proceedings:
JUVIER and his co-conspirators set up and operated multiple health care clinics in New York City that purported to provide injection and infusion treatments to Medicare-eligible HIV/AIDS patients, but that were, in reality, health care fraud mills (the “Clinics”), that routinely billed Medicare for medications that were never provided or were provided at highly diluted doses and that were often unnecessary because the person being “treated” did not medically need the treatments.
JUVIER and his co-conspirators executed the fraudulent scheme by recruiting HIV/AIDS patients who were eligible for Medicare to come to the Clinics multiple times per week, for multiple months, to undergo expensive “treatments” that were often unnecessary. The purported treatments included drugs costing hundreds of dollars each to administer and typically reserved for cancer and anemia patients. JUVIER and his co-conspirators paid the patients cash kickbacks of up to $300 per week in exchange for coming to the Clinics and agreeing to undergo the treatments. Patients were also offered approximately $50 for each additional patient they referred to the Clinics. JUVIER and his co-conspirators then used these patients’ status as Medicare beneficiaries to submit claims to Medicare for reimbursement for the treatments purportedly administered to the patients, often receiving tens of thousands of dollars in reimbursements per patient. However, in truth, the treatments typically were provided in highly diluted doses or not provided at all, and were often medically unnecessary. As a result of the scheme, from 2010 through 2013, JUVIER and his co-conspirators defrauded the Medicare system out of at least $12 million.
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JUVIER, 56, a resident of Manhattan, pled guilty to one count of conspiracy to commit health care fraud, which carries a maximum sentence of 10 years in prison. The statutory maximum sentence is prescribed by Congress and provided here for informational purposes only, as any sentencing of the defendant would be determined by the judge. As part of his plea, JUVIER agreed to pay over $12 million in forfeiture and restitution. JUVIER is scheduled to be sentenced by Judge Kimba Wood on May 18, 2015, at 11:00 a.m.
Oscar Huachillo, 54, of Manhattan, has been charged separately in connection with the Medicare fraud scheme. Huachillo pled guilty before U.S. District Judge Katherine Polk Failla on July 1, 2014, and is scheduled to be sentenced by Judge Failla on Thursday, March 5, 2015, at 3:30 p.m.
Mr. Bharara praised the outstanding efforts of HHS-OIG, IRS-CI, and the FBI in the investigation.
This case is being handled by the Office’s Complex Frauds and Cybercrime Unit. Assistant U.S. Attorney Jonathan Cohen is in charge of the prosecution.