MIAMI--The operators of several HME companies that defrauded Medicare of more than $22 million are set for sentencing in three separate cases announced last week by the U.S. Attorney for the Southern District of Florida and the Miami Field Office of the FBI.
The cases are part of a massive crackdown on health care fraud in South Florida that was announced earlier in the year by U.S. Attorney R. Alexander Acosta of the Southern District of Florida and the Department of Justice. (See
HomeCare Monday, May 14.) Since March, the Medicare Fraud Strike Force has brought over 70 cases of health care fraud involving 85 defendants, authorities said.In the largest of the three cases, the owner of two Miami-based HMEs pleaded guilty Aug. 31 to defrauding Medicare in a $6.4 million scheme. Raul Rodriguez, 34, of Miramar, owner of R & J Medical Services and N.R. Medical Services, pleaded guilty to four separate counts of health care fraud, money laundering and conspiracy to obstruct an FBI investigation, prosecutors said.
Rodriguez, who also owned Coral Way Professional Health Services, an HIV medical clinic, agreed to a $5.7 million judgment and forfeiture of a bank account, cash and a $100,000 Land Rover. He faces a maximum sentence of 20 years in prison and potential fines of $12.8 million. He will be sentenced Nov. 30.
Rodriguez became the eighth defendant to plead guilty in the case. Armando Arias, Carlos Enrique Monteagudo, Alain Rhaf Vega, Marisol Gonzalez-Torres, Edith Balog, Yulen Arderi and Jannette Morales entered guilty pleas in August. Two others, Lazaro Jorge Ocejo and Ramon De Los Santos, were sentenced earlier this year on fraud conspiracy and money laundering charges in related cases. De Los Santos was sentenced to a prison term of 21 months, while Ocejo was sentenced to 37 months.
According to the authorities, from 2004 through 2005, Rodriguez and the co-defendants submitted more than $12.5 million in false and fraudulent claims for medical equipment, HIV treatments and medications. The scheme involved recruiting and paying patients to be treated at the Coral Way clinic. The patients were injected with saline instead of prescribed drugs, Rodriguez, Arias and Gonzalez-Torres admitted.
Rodriguez and Arias laundered much of the fraud proceeds through shell corporations set up for the sole purpose of concealing the illicit monies, authorities said. Beginning in September 2005, Rodriguez and Arias, who also pled guilty to a conspiracy charge, met with potential government witnesses and encouraged them to lie to FBI agents and/or a federal grand jury. That continued through March of this year, authorities said.
Two other cases involving HME providers also were announced last week.
Gianni Suarez Vazquez pleaded guilty to a multi-million-dollar money laundering and mail fraud scheme. According to court records, Suarez Vazquez set up two medical equipment companies, GK Medical and Suplident International Corp., in Palm Beach County between November 2003 and August 2004. He concealed his ownership of the companies and instead used nominee owners, including his mother, to obtain Medicare provider numbers for both companies.
Using bogus prescriptions and CMNs with forged physicians' signatures, Suarez Vazquez and his unnamed partners, through Miami billing companies, submitted a total of $9.8 million in fraudulent claims that Medicare reimbursed.
Suarez Vazquez will be sentenced on Nov. 15.
And in a case involving aerosol medications, Marianela Smith, owner of Smith Medical Equipment and M.P. Residence, an assisted living facility in Miami, was found guilty by a federal grand jury of conspiracy to defraud the U.S. government, submitting false claims to Medicare, conspiracy to commit health care fraud and three counts of receiving kickbacks in exchange for referring patients to a co-conspirator pharmacy.
According to a statement from the U.S. Attorney's office, Smith conspired with the owners of Lily's Pharmacy to refer paid patients to the pharmacy in exchange for half of what Medicare paid for compounded aerosols. Smith referred at least 48 patients and their Medicare billing information to Lily's. Along with those patients, Smith provided phony prescriptions for compounded aerosol meds purchased from local physicians.
One of the patients testified during the seven-day trial that Smith paid him $150 per month to use his Medicare card and to obtain phony prescriptions in his name that were ultimately provided to the pharmacy, the statement said. Lily's billed Medicare more than $271,000 using the phony prescriptions provided by Smith. In exchange, Smith received more than $81,000 in kickbacks.
"Trial testimony established that compounding was done for the sole purpose of defrauding Medicare, and the prescriptions were predetermined before any of the over 1,000 beneficiaries at Lily's saw a physician or received a prescription," the statement said.
Smith faces a maximum sentence of 30 years imprisonment. She will be sentenced Nov. 9.
In 2006, Medicare paid for more than $155 million in aerosol medications in Miami-Dade County alone, according to the statement. These drugs were the single most common item billed to Medicare Part B and accounted for more than 32 percent of all claims filed in the county.
Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan and Ohio, the statement said.
