Miami Couple Sentenced For Operating Clinic To Defraud Medicare

Tampa, FL – U.S. District Judge Susan C. Bucklew sentenced a Miami couple today for their roles in operating a sham clinic. Gladys Fuertes (41) was sentenced to 19 years and 6 months in federal prison for engaging in a conspiracy to commit healthcare fraud, healthcare fraud, aggravated identity theft, and obstruction of a healthcare fraud investigation. Her husband and business partner, Mario Fuertes (41) was sentenced to 11 years and 3 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, and obstruction of a healthcare fraud investigation.  The Court also ordered them to forfeit $1,036,759.72, proceeds that are traceable to the charged conduct.  The Fuerteses were convicted by a federal jury on March 24, 2015.

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 had been present or had 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.

“Today, Gladys and Mario Fuertes found out what health care providers who defraud Medicare are finding out all over America:  if you commit health care fraud, you will be held accountable for your greed.  From billing for services never provided to selling fraudulent narcotic prescriptions to altering medical records to conceal their crimes, this couple earned their stiff prison sentences,” said Special Agent in Charge Shimon R. Richmond, U.S. Department of Health and Human Services Office of Inspector General.  “HHS OIG special agents will continue to work closely with our State and Federal law enforcement partners to protect Federal health care programs and the patients they serve.”        

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 was prosecuted by Assistant United States Attorneys Mandy Riedel and Kelley Howard-Allen.

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.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.