Miami Home Health Nurse Sentenced to 10 Years’ Imprisonment for Health Care Fraud
| U.S. Attorney’s Office August 08, 2011 |
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigations, announced today’s sentencing of Armando Santos, 46, of Miami. In May 2001, a federal jury in Miami convicted Santos of one count of conspiracy to commit health care fraud, in violation of Title 18, United States Code, Section 1349; four counts of health care fraud, in violation of Title 18, United States Code, Section 1347, and two counts of false statements related to health care matters, in violation of Title 18, United States Code, Section 1035.
Chief U.S. District Judge Federico Moreno sentenced Santos to the statutory maximum of 10 years’ imprisonment as to each of the fraud charges, and five years’ imprisonment as to each of the false statement charges. The counts of conviction are to run concurrent to one another.
According to the evidence presented at trial, Santos was a registered nurse employed by a Miami-Dade based home health care agency called Ideal Home Health. As part of his job as a home health nurse, Santos was paid to provide skilled nursing services to Medicare beneficiaries that were homebound, diabetic, insulin dependent, and so ill that they were unable to inject themselves with insulin. Under Medicare regulations, Santos was required to keep records of each time he provided a skilled nursing service to a Medicare beneficiary. Between June 27, 2007 and March 13, 2009, Santos completed hundreds of documents in which he claimed that he had injected Medicare beneficiaries with insulin two times a day, seven days per week.
At trial, however, the evidence showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin twice daily, seven days per week, were neither in need of insulin nor homebound. The evidence also showed that the defendant claimed to be treating two separate Medicare beneficiaries at the same time. The defendant’s false statements resulted in the submission of $230,315 in false claims to Medicare for services that were either not medically necessary or actually provided to Medicare beneficiaries.
The owners of Ideal Home Health, Elizabeth Acosta Sanz and Luis Alejandro Sanz, both of Miami, were recently arrested and charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay kickbacks, the payment of kickbacks, conspiracy to commit money laundering, and money laundering, in violation of Title 18, United States Code, Sections 1349, 1347, 371 and 1956, respectively.
According to those charges, Elizabeth Acosta Sanz and Luis Alejandro Sanz, husband and wife, owned Ideal Home Health and used Ideal submit fraudulent claims to Medicare for home health services that were neither medically necessary nor actually provided to Medicare beneficiaries. More specifically, the indictment alleges that from August 2006 through March 2009, the defendants offered and paid kickbacks to recruiters and others. These individuals, in turn, paid Medicare beneficiaries to induce them to agree to be serviced by Ideal. In addition, the defendants instructed nurses to falsify patient medical records to make it appear that the Medicare beneficiaries qualified for and received home health services. In fact, however, the services were not medically necessary and had not been provided. In this way, these defendants submitted approximately $11,340,342 in false claims to Medicare, of which Medicare paid $7,317,879.
Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. These case are being prosecuted by Assistant U.S. Attorneys Daniel Bernstein, H. Ron Davidson and Michael O’Leary.
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 http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.