Federal Jury Finds Husband and Wife Guilty of Operating a Clinic to Defraud Medicare
TAMPA, FL—United States Attorney A. Lee Bentley, III announces that a federal jury has found Miami residents Gladys Fuertes (40) and her husband, Mario Fuertes (38), guilty of conspiracy to commit health care fraud, health care fraud, and obstructing a health care investigation. They are facing a maximum penalty of 10 years in federal prison on the conspiracy count and on each of the 10 health care fraud counts, and up to five years in federal prison on each of the two obstruction counts. Gladys Fuertes was also convicted of four counts of aggravated identity theft and faces a mandatory sentence of two years in prison for those charges. The sentencing hearing has been scheduled for June 23, 2015. Both individuals were indicted on March 13, 2014, and arrested in Miami on March 26, 2014.
According to evidence presented during the seven-day trial, Gladys and Mario Fuertes established and operated a sham clinic, Gables Medical and Therapy Center, for the purpose of committing health care fraud. They employed unlicensed medical professionals and misused the Medicare billing numbers of other medical professionals, without their knowledge, in order to claim that they had rendered medical treatment to Gables patients. The Fuerteses also paid a co-conspirator to recruit Medicare beneficiaries for Gables, and to drive patients to the clinic for basic and sham medical services.
Once recruited, Gladys and Mario Fuertes urged the Gables patients to enroll in Universal’s Medicare Part C and Part D plans. They believed that Universal paid a relatively high percentage of its claims. The Fuerteses fraudulently billed Universal and caused Universal’s Medicare Part C plan to be billed for Gables patients’ supposed treatments. The treatments included expensive HIV-related treatments that patients never actually received. Gladys and Mario Fuertes also billed Universal and caused Universal to be billed for services that required a physician’s presence when no licensed physician was present or rendered the service. The Fuerteses billed Universal in excess of $900,000.
The Fuerteses and their co-conspirators paid the Medicare beneficiaries, who were recruited to come to Gables for their Medicare identification numbers, to allow Gables to bill Universal for services that were never rendered. In addition, Gladys and Mario Fuertes facilitated the provision of fraudulent prescriptions for controlled substances, including oxycodone, to Gables patients. In some cases, the signatures on the prescriptions were forged. The patients who received these oxycodone prescriptions were assisted in filling them by a co-conspirator. The co-conspirator also purchased the pills from some of the patients and sold them on the street. These prescriptions were paid for as part of the beneficiaries’ Medicare Part D benefits.
Once they learned of the federal health care fraud investigation into their actions, the Fuerteses instructed Gables patients to lie to law enforcement agents and otherwise obstruct a federal investigation into health care fraud at the clinic. The Fuerteses also provided altered Medicare billing documentation to federal agents investigating their activities.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General and the Federal Bureau of Investigation. It is being prosecuted by Assistant United States Attorneys Mandy Riedel and Kelley Howard-Allen.
Since its inception in March 2007, the Medicare Strike Force, now operating in nine cities across the country, has charged more than 1,900 defendants who have collectively billed the Medicare Program for more than $6 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.
To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to:http://www.stopmedicarefraud.gov/.