Three Patient Recruiters for Miami Home Health Companies Sentenced to Prison in $25 Million Health Care Fraud Scheme

WASHINGTON—Two patient recruiters for a Miami health care agency were sentenced today to 18 and 12 months in prison, respectively, for their 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).

U.S. District Judge Joan A. Lenard in Miami sentenced Oscar Martinez, 54, to 18 months in prison, three years of supervised release and ordered Martinez to pay $390,000 in restitution. Judge Lenard sentenced Lesder Casanova, 40, to 12 months in prison, three years of supervised release and ordered Casanova to pay $195,000 in restitution.

In addition, on Dec. 12, 2011, co-conspirator patient recruiter Raul Alvarez, 48, was sentenced by Judge Lenard to 10 months in prison for his role in the fraud scheme. Alvarez was also sentenced to three years of supervised release and ordered to pay $118,000 in restitution.

Alvarez, Martinez and Casanova each pleaded guilty earlier this year to one count of conspiracy to commit health care fraud. They were each ordered to pay their restitution jointly and severally with co-defendants.

According to court documents, Casanova was a patient recruiter for ABC Home Health Care Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Alvarez and Martinez were patient recruiters for Florida Home Health Care Providers Inc., another related Miami home health care agency. According to court documents, ABC and Florida Home Health only existed to defraud Medicare.

Alvarez, Martinez and Casanova admitted that beginning in approximately January 2006 and continuing until approximately March 2009, they recruited Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. Alvarez, Martinez and Casanova solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for the recruited patients. According to their pleas, Alvarez, Martinez and Casanova knew that the patients they recruited did not qualify for the services billed to Medicare. In addition, the defendants knew that the patient files for their recruited patients were falsified in order to make it appear that the patients qualified for the services.

As a result of the participation of Alvarez, Martinez and Casanova in the illegal scheme, the Medicare program was billed approximately $118,000, $390,000 and $195,000, respectively, for purported home health care services that were not medically necessary and/or were not provided.

Last week, Dr. Jose Nunez was sentenced to 40 months in prison for his role in the fraud scheme and two nurses, Luisa Morciego and Eneida Fry, were each sentenced to 24 months in prison for their roles in the scheme. Another patient recruiter, Vincente Guerra-Nistal, was sentenced to 18 months in prison in October 2011.

The sentences 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 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 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 Action Team (HEAT), go to: www.stopmedicarefraud.gov.