U.S. Attorney's Office for the Southern District of Florida issued the following announcement on Sept. 26.
Ariana Fajardo Orshan, U.S. Attorney for the Southern District of Florida; Brian A. Benczkowski, Assistant Attorney General for the Justice Department’s Criminal Division; George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Derrick L. Jackson, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG), Atlanta Regional Office, announced that a total of 30 defendants were charged with offenses relating to their alleged participation in various schemes to defraud Medicare, Medicaid and private insurance. The conduct allegedly resulted in more than $86 million in fraudulent billings. Those charged included physicians as well as other medical and business professionals.
The charges announced involve schemes alleged to have billed Medicare, Medicaid and private insurance companies for medically unnecessary services, such as home health, prescriptions drugs, durable medical equipment and addiction treatment services.
“Health care programs provide vital services to Americans,” said U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida. “Those who perpetuate these pervasive health care fraud schemes steal taxpayer dollars from intended beneficiaries and threaten the viability of government programs. We commend the coordinated and continued efforts of our federal law enforcement partners to root out fraud and abuse in our healthcare system.”
“The defendants charged allegedly bilked the American people to the tune of millions in fraudulent billings,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “All Americans should stand with the Department as we fight the fight against these unscrupulous schemes in Florida, Georgia, and across the country.”
“Being a healthcare professional in the Medicare program is a privilege, not a right. When physicians and other healthcare providers put their own financial gain above patient well-being and honest billing of government health programs, they violate the basic trust that taxpayers extend to healthcare professionals,” said Special Agent in Charge Derrick L. Jackson of the HHS-OIG Atlanta Regional Office. “It arrests puts corrupt medical professionals on alert that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal health care programs.”
“The FBI and its federal, state and local partners are working tirelessly every day to detect and combat schemes like those announced ,” said Special Agent in Charge George L. Piro of the FBI’s Miami Field Office. “Despite our efforts, we still need the public's help in reporting suspicious activity. If anyone suspects they are a victim of health care fraud please call your local FBI office or the HHS Office of Inspector General.”
The following are some of the health care fraud cases have been charged recently in the Southern District of Florida:
Substance Abuse Treatment:
U.S. v. Peter Port, Brian Dublynn, & Jennifer Sanford, Case No. 19-20583-CR-Williams
Peter Port, 64, of Boca Raton, Brian Dublynn, 62, of Fort Lauderdale, and Jennifer Sanford, 57, of Hollywood, were charged for their alleged participation in a scheme to defraud private health insurance companies. Port, Dublynn and Sanford were each charged with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud. In addition, Port and Dublynn were each charged with one count of conspiracy to commit money laundering and five counts of money laundering. The defendants caused Safe Haven Recovery Inc. (Safe Haven), a substance abuse treatment facility in Miami, and several clinical laboratories to submit false and fraudulent claims to health insurance plans for addiction treatment services that were not provided as billed and laboratory tests that were not medically necessary. DOJ Trial Attorney David A. Snider is prosecuting this case.
Home Health:
U.S. v. Dr. Richard S. Mallia, Case No. 19-20623-CR-Altonaga
Richard S. Mallia, D.P.M., 55, a podiatrist, was charged by indictment with one count of conspiracy to defraud the United States and to receive kickbacks, one count of conspiracy to commit health care fraud and wire fraud, and three counts of health care fraud, for his role in a health care fraud conspiracy that caused a loss of approximately $7.7 million to the Medicare program. The indictment alleges that Mallia accepted cash kickbacks in exchange for writing medically unnecessary home health prescriptions and also participated in a scheme to submit claims to Medicare for relatively expensive foot procedures that he never performed. DOJ Trial Attorney Alexander Thor Pogozelski is prosecuting this case.
U.S. v. Maribel Sera, Case No. 19-20625-CR-Williams
Maribel Sera, 51, of Hialeah, was charged by information with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program. According to the information, the defendant participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to TC Home Health Care of Hialeah. Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.
U.S. v. Juan Jose Mesa, et al., Case No. 19-20574-CR-Gayles
Juan Jose Mesa, 58, and Madelaine Varona, 47, both of Miami, owners and/or operators of All Excellent OT-PT Service LLC of Miami and Cruz Healthcare Corp. of Miami, respectively; Sandra Cardona, 47, of Hialeah, an allegedly unlicensed therapist; and Silvia Salvatori, 67, of Pembroke Pines, Florida, a licensed massage therapist, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud. Mesa and Varona were also charged with five and six counts of health care fraud, respectively. The charges stem from Mesa’s and Varona’s alleged roles in a scheme to defraud Part A of the Medicare program of more than $4 million by billing for home health services that were not rendered and paying kickbacks to patient recruiters in exchange for patient referrals. Cardona and Salvatori, who were allegedly not licensed to provide physical therapy, accepted payment from a licensed physical therapist, paid by their co-conspirators, in exchange for allegedly obtaining signed patient visitation forms from Medicare beneficiaries used to submit false and fraudulent claims. Assistant U.S. Attorney Kevin Larsen is prosecuting this case.
U.S. v. Sara Tania Ruiz and Maria Laura Prieto, Case No. 19-20588-CR-Moore
Sara Tania Ruiz, 55, of Hialeah, and Maria Laura Prieto, 60, of Miami, were charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program. According to the indictment, the defendants participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies, including ACM Home Health Corp. of Miami and TC Home Health Care Inc. of Hialeah. Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.
U.S. v. Marisol Padilla, Case No. 19-20589-CR-Martinez
Marisol Padilla, 48, of Hialeah, was charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program. According to the indictment, the defendant participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to TC Home Health Care of Hialeah. Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.
U.S. v. Ana Maria Fernandez and Berta Leon, Case No. 19-20573-CR-Ungaro
Ana Maria Fernandez, 62, and Berta Leon, 69, of Miami, Florida, were charged with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program. According to the indictment, the defendants participated in a conspiracy to use their company ABC Medical Solutions Corp. of Miami, to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies, including ACM Home Health Corp. of Miami and TC Home Health Care Inc. of Hialeah, Florida. Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.
U.S. v. Jocelyn De La Caridad Perez and Joaquin Guevara, Case No. 19-20582-CR-Altonaga
Jocelyn De La Caridad Perez, 41, and Joaquin Guevara, 46, both of Miami, were charged by indictment with one count of conspiracy to receive health care kickbacks. Perez was also charged with one count of conspiracy to commit health care fraud and wire fraud, and Guevara was also charged with three counts of receipt of kickbacks in connection with a federal health care program. According to the indictment, Perez was an administrator of Joe Rehabilitation and Diagnostic, Inc. (Joe Rehab), an outpatient rehabilitation facility in Doral, Florida, that purportedly provided therapy services to Medicare beneficiaries. As part of the fraudulent scheme, Perez allegedly conspired with others to pay kickbacks and bribes for the referral of Medicare beneficiaries to Joe Rehab so their information could be used to submit fraudulent claims to Medicare for services purportedly provided, regardless of whether the Medicare beneficiaries needed or received the services. Assistant U.S. Attorney Anne P. McNamara is prosecuting this case.
Private Insurance:
U.S. v. Ivan Bejerano, Case No. 19-20591-CR-King
Ivan Bejerano, 49, of Miami, was charged by indictment with seven counts of health care fraud and one count of conspiracy to commit health care and wire fraud. According to the indictment, Dynamic Physical Rehab Inc. (Dynamic) was a Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. From June 2017 through July 2019, Bejerano allegedly submitted and caused the submission of claims, via interstate wires, totaling approximately $2.5 million that falsely and fraudulently represented that various health care benefits, primarily physical therapy, were medically necessary, prescribed by a doctor, and had been provided by Dynamic to insurance beneficiaries of Blue Cross Blue Shield (BCBS). Assistant U.S. Attorney Shannon Shaw is prosecuting this case.
U.S. v. Deivys Ernesto Alvarez, Case No. 19-20604-CR-Bloom
Deivys Ernesto Alvarez, 48, of Hialeah, was charged by indictment with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud. According to the indictment, Alvarez was the owner of Diagnostic Center of Medley Inc., a Miami medical clinic. AP & JL Medical Center Inc. (AP & JL) was another Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. Alvarez and co-conspirators allegedly recruited and paid Comcast Corp. and Telemundo Corp. employees, through Diagnostic Center of Medley Inc., and referred those employees and/or the employees’ personal information to AP & JL to fraudulently bill BCBS. Alvarez and his co-conspirators allegedly submitted and caused the submission of false and fraudulent claims, via interstate wires, totaling approximately $800,500. Assistant U.S. Attorney Timothy J. Abraham is prosecuted this case.
U.S. v. Francisco Abreu Tartabull, Case No. 19-20605-CR-Altonaga
Francisco Abreu Tartabull, 53, of Miami, was charged by indictment with conspiracy to commit health care fraud and wire fraud in connection with his role in a $2.1 million private insurance fraud scheme. According to the indictment, Tartabull was the owner and operator of South Dade Medical Center Inc. (South Dade), a Miami medical clinic that purportedly provided Blue Cross Blue Shield insurance beneficiaries with various medical treatments and services. As part of the fraudulent scheme, Tartabull and his co-conspirators submitted more than $2.1 million in fraudulent claims to Blue Cross Blue Shield. These claims falsely represented that the benefits Tartabull’s clinic had billed insurance for were medically necessary, prescribed by a doctor, and had been provided by South Dade to these beneficiaries. As a result of these false claims, Blue Cross Blue Shield paid Tartabull’s clinic more than $920,000. Tartabull then used this ill-gotten money for his own personal use and benefit, and to further the fraud. The FBI investigated this case. Assistant U.S. Attorney Anne P. McNamara is prosecuting this case. Assistant U.S. Attorney Anne P. McNamara is prosecuting this case.
Pharmacy:
U.S. v. Elba Cobos Baile and Yolanda Castano, Case No. 19-20581-CR-Cooke
Elba Cobos Baile, 60, and Yolanda Castano, 55, both of Miami, were charged by indictment with four counts of health care fraud and one count of conspiracy to commit health care fraud and wire fraud. Cobos and Castano were the owners and operators of Pharmacy Solution, a retail pharmacy in Miami-Dade County. The indictment alleges that from on or about March 1, 2012 to September 17, 2014, Cobos and Castano submitted and caused the submission of claims, via interstate wires, which falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor and had been provided by Pharmacy Solution to Medicare beneficiaries. As a result of these false and fraudulent claims, Medicare prescription drug plan sponsors allegedly made payments funded by the Medicare Part D Program to the corporate bank accounts of Pharmacy Solution in the approximate amount of at least $2.1 million. Assistant U.S. Attorney Christopher J. Clark is prosecuting this case.
U.S. v. Tania Rodriguez and Rafael Vidal, Case No. 19-20584-CR-King
Tania Rodriguez, 48, and Rafael Vidal, 61, both of Miami, were charged by indictment with one count of conspiracy to commit healthcare and wire fraud and seven counts of health care fraud. According to the indictment, the defendants participated in a conspiracy to use their company, American United Pharmacy Corp. of Miami, to offer and pay kickbacks for the referral of Medicare beneficiaries to their pharmacy, and to submit false and fraudulent claims to Medicare for prescription drugs that were not provided to Medicare beneficiaries. Assistant U.S. Attorney David Turken is prosecuting this case.
U.S. v. Ricardo Ignacio Perez and Ricardo Perez-Leon, Case No. 19-20594-CR-Williams
Ricardo Ignacio Perez, 54, and Ricardo Perez-Leon, 31, both of Miami, the owners and operators of three Miami pharmacies, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud; one count of conspiracy to defraud the United States and pay and receive health care kickbacks; and three counts of health care fraud. The indictment alleges that the defendants participated in a scheme to pay kickbacks and bribes to patient recruiters and to fraudulently bill Medicare drug plan sponsors for prescription medications. The indictment alleges that, during the course of the fraudulent scheme, the defendants received approximately $5.3 million from Medicare drug plan sponsors for prescription medications that were medically unnecessary, never provided and/or never purchased by the defendants’ pharmacies. DOJ Trial Attorneys Sara Clingan and Tim Loper are prosecuting the case.
Durable Medical Equipment:
U.S. v. Steven Kahn and Pamela Edwin, Case No. 19-80169-CR-Rosenberg
Steven Kahn, 61, of Boca Raton, and Pamela Edwin, 33, of Delray Beach, the owner and office manager, respectively, of a Broward county telemedicine company, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud and three counts of wire fraud. Kahn was also charged with five counts of money laundering. The indictment alleges that the defendants paid kickbacks and bribes to physicians in exchange for signing doctors’ orders, and that the defendants then sold the doctors’ orders to Medicare providers who used the orders to submit approximately $39 million in fraudulent claims to Medicare. DOJ Trial Attorneys Sara Clingan and Catherine Wagner are prosecuting the case.
U.S. v. Jordan Karlick, Michael Moranz and Jordan Chibnick, Case No. 19-80168-CR-Rosenberg
Jordan Karlick, 33, of Boca Raton, Michael Moranz, 32, of Lake Worth, and Jordan Chibnick, 36, of Plantation, the owners of Palm Beach durable medical equipment (DME) companies, were charged by indictment with one count of conspiracy to commit healthcare fraud and wire fraud, one count of conspiracy to defraud the United States and pay kickbacks, four counts of health care fraud, and three counts of payment of kickbacks. The indictment alleges that the defendants paid kickbacks and bribes in exchange for signed doctors’ orders for DME, which the defendants used to fraudulently bill Medicare for over $23 million. The indictment alleges that defendants sought to impede Medicare beneficiary’s ability to return DME that they did not want or need to defendants’ companies, so that defendants could continue to bill Medicare for that DME. DOJ Trial Attorneys Sara Clingan and Catherine Wagner are prosecuting the case.
U.S. Attorney Fajardo Orshan commends the investigative efforts of HHS-OIG and FBI.
A criminal complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
The Fraud Section leads the Medicare Fraud Strike Force (MFSF), which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Original source can be found here.