Patient Recruiter for Miami Health Care Agency Pleads Guilty in $25 Million Medicare Fraud Scheme

WASHINGTON—A patient recruiter for a Miami health care agency pleaded guilty today to his participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Vicente Guerra-Nistal, 54, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. Guerra was charged in a February 2011 indictment. According to plea documents, Guerra was a patient recruiter for ABC Home Health Care Inc. ABC was a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.

According to court documents, ABC was operated for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were medically unnecessary and/or were never provided. Court documents allege that the medically unnecessary services were prescribed by doctors, including Jose Nunez, M.D., and Francisco Gonzalez, M.D. Nunez and Gonzalez were also charged in the February 2011 indictment along with Guerra, and 18 other co-conspirators.

According to court documents, beginning in approximately January 2006, and continuing until approximately March 2009, Guerra offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing ABC to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. Guerra was paid kickbacks and bribes by the owners of ABC in return for recruiting the Medicare beneficiaries to ABC. Guerra admitted that he knew the patients he recruited for ABC did not qualify for the services that ABC billed to Medicare. In addition, Guerra knew that the patient files for his recruited patients were falsified in order to make it appear that the patients qualified for home health care and therapy services so that Medicare could be billed for medically unnecessary services.

As a result of Guerra’s participation in the illegal scheme, the Medicare program was billed approximately $194,000 for purported home health care services that were medically unnecessary and/or were never provided.

Sentencing has been scheduled for Oct. 17, 2011. The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.

Co-defendants Lisandra Alonso and Luisa Morciego pleaded guilty for their roles in the fraud scheme on July 13, 2011. Drs. Nunez and Gonzalez are scheduled to begin trial on Oct. 10, 2011. An indictment is merely a charge and defendants are presumed innocent until proven guilty.

Today’s charges were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami.

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 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.