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“False billings, diversion of drugs and medical equipment, and other types of health care fraud cost taxpayers millions of dollars annually. More importantly, health care fraud endangers the health and well-being of our patients. With the assistance of our federal and state law enforcement partners, we want South Floridians to know that we will take aggressive efforts to combat fraud against Medicare, Medicaid, and other health insurance programs,” said Acosta. "These cases pose a serious threat to the citizens of Florida. In particular, however, there are few actions lower than trying to profit from drugs intended for AIDS patients," said Florida Attorney General Charlie Crist. "These arrests represent an outstanding example of teamwork paying off for the people of Florida. U.S. Attorney Alexander Acosta and his team were wonderful partners in this successful effort to shut down a black market operation." FBI Special Agent in Charge Michael Clemens stated, "Criminals who commit health care fraud steal from U.S. taxpayers and make medical care more expensive for all of us. The FBI recognizes the prevalence of health care fraud in South Florida and we will continue to work with our partners to combat this crime problem." “There is no question that South Florida health care fraud challenges the law enforcement community with its numerous scams and aggressive perpetrators," said Linda Little, Special Agent in Charge of the OIG Regional Office of the Department of Health and Human Services. "But we do not shrink from that challenge and are totally committed to curbing the scourge of health care fraud in South Florida," Little concluded. United States Attorney Acosta noted that since mid-June 2005, the U.S. Attorney’s Office has charged sixty-four (64) defendants in twenty-eight (28) separate criminal cases. The fraud in these cases resulted in approximate losses to Medicare, Medicaid, and other health insurance programs of more than $20 million. In addition, during this same time period, the Civil Division of United States Attorney’s has obtained seven (7) civil injunctions in lawsuits filed to freeze health care fraud proceeds. The alleged amount of loss to the government in these civil cases is at least an additional $14 million. Specifically, Acosta announced recently filed criminal charges against twenty (20) health care fraud defendants in twelve (12) separate cases. A summary of the newly announced cases follows: (1) United States v. Onelio S. Baez, et. al., Case No. 05-20849-CR-Martinez. This joint federal and Florida State Attorney General - Medicaid Fraud Control Unit, investigation culminated in the November 23, 2005, arrests of Onelio S. Baez, Juan Carlos Mateo, Jorge Arnaldo Valido, and Luis Jacinto Marti. The resulting sixteen (16) count federal Indictment charges the defendants with conspiracy and health care fraud in connection with an AIDS or HIV prescription drug diversion and fraudulent billing scheme that caused at least $1 million in losses to the Florida Medicaid program. According to the Indictment, Onelio Baez directed patient recruiters, including co-defendant Juan Carlos Mateo, to recruit and pay kickbacks to Medicaid patients to visit certain medical clinics. Physicians at these clinics, including co-defendants Valido and Marti, would write medically unnecessary prescriptions for Intravenous Immune Globulin (IVIG) drugs. IVIG drugs are often used to treat cancer patients and those patients with immune disorders, such as AIDS or HIV. The prescriptions were then filled at various pharmacies, which in turn, billed Medicaid for the cost of the unnecessary IVIG drugs. To complete the fraud, the drugs were not delivered to any patients, but, at Baez’s direction, were diverted to another Miami pharmacy and resold for profit. The case is being prosecuted by Medicaid Fraud Control Unit prosecutors Stephen LeClair and Louis Martinez, who have both been cross-designated as Special Assistant United States Attorneys. Frauds against the Florida Medicaid program, which is administered by the State of Florida and funded jointly by the State and the federal governments, are typically prosecuted in State court. The Baez case, however, illustrates how federal and state law enforcement have joined forces to prosecute Medicaid fraud in federal court, where sentencing guidelines for fraud cases often allow stiffer sentences. (2) United States v. Ahmed Pons, et al., Case No. 05-20721-CR-Gold. On November 29, 2005, a grand jury in Miami returned a Superseding Indictment adding defendant Ahmed Pons to an existing September 2005 indictment charging him and co-defendants Santos Infante, Juan Carlos Olive, Diomar Ortega, and Sergio Ortega with a scheme to defraud Medicare through the submission of false claims concerning Miami-area durable medical equipment (DME) companies. In addition, Pons, Infante, and Olive are charged with a money-laundering conspiracy and twenty-seven (27) counts of money laundering. In August 2005, the United States Attorney’s Office filed a related civil injunctive action to freeze fraud proceeds, United States v. Med Solutions Rentals & Sales, Inc., Case No. 05-20721-CIV-Gold. On August 30th, a preliminary injunction order was entered against various defendants, including Infante, Olive, and the Ortegas. Assistant United States Attorney Robert N. Nicholson is assigned to the criminal and civil cases, which were investigated by the FBI and HHS-OIG. (3) United States v. Pedro Diaz, et. al., Case No. 05-20869-CR-Cooke. On November 23, 2005, defendant Pedro Diaz was arrested in connection with a seven (7) count Indictment. The Indictment charges Diaz and co-defendant Rodolfo Augila with conspiracy and health care fraud in the operation of Sunset Rehabilitation Center, a Miami medical clinic that received approximately $1.5 million in Medicare payments for AIDS/HIV medications that were either medically unnecessary or never provided. Defendant Aguila has not yet been arrested. The matter was investigated by the FBI and is being prosecuted by AUSA Barbara Martinez. (4) United States v. Magda Lavin, Case No. 05-20814-CR-Lenard. On November 9, 2005, defendant Magda Lavin was arrested in connection with a twelve (12) count Indictment charging her with conspiracy and health care fraud in the operation of two medical clinics that received approximately $5 million in Medicare payments for AIDS/HIV medications. Again, these medications were either medically unnecessary or were never provided to patients. Trial is scheduled for December 12, 2005. The criminal case was investigated by the FBI and is being prosecuted by AUSA Barbara Martinez. The Lavin and Diaz prosecutions were the result of a long term federal investigation that, to date, has resulted in four separate Indictments against thirteen (13) defendants, including three doctors, for conspiracy, health care fraud, and money laundering charges. The three doctors, Jose Vega, Jorge Humberto Forcada, and Clark Carlton Mitchell, were convicted earlier this year of various felony charges and were sentenced to prison terms ranging from 33 to 54 months. In addition to the criminal charges, the investigation included a parallel civil injunctive lawsuit, United States v. Bolanos Institute, et al., No. 03-21837-CIV-Martinez, which resulted in freezing $600,000 in various bank accounts. A default judgment was entered in the United States’ favor in the civil suit in 2004. The civil lawsuit was handled by former Assistant United States Attorney Lisa Hu Barquist. (5) United States v. Antonio Hevia, Case No. 05-20868-CR-Ungaro-Benages. On November 21, 2005, the United States Attorney’s Office filed an Information charging defendant Antonio Hevia with conspiracy to commit health care fraud. The Information alleges that Hevia recruited and paid kickbacks to Medicare patients for access to their patient identification information. Several Miami durable medical equipment (DME) companies then used the patient information to submit fraudulent claims to Medicare for the cost of DME purportedly provided to the patients. Hevia is scheduled to make his initial appearance in United States Magistrate Court in Miami on December 2, 2005. This case is being prosecuted by Assistant United States Attorney Luis M. Pérez. (6) United States v. Miguel Ugarte, Case No. 05-20867-CR-Cooke. On November 21, 2005, the United States Attorney’s Office filed an Information charging defendant Miguel Ugarte with conspiracy to commit health care fraud. The Information alleges that Ugarte, an orthotist, was paid to sign forms indicating that he had fitted Medicare patients for specialized orthotic equipment, for which Medicare was fraudulently billed by various Miami DME companies. According to the Information, Ugarte never saw the patients. Ugarte is scheduled to make his initial appearance in United States Magistrate Court in Miami on December 2, 2005. The Hevia and Ugarte cases are the latest prosecutions arising from Operation Wash Rag, an investigation conducted by the FBI and HHS-OIG. To date, this investigation has resulted in the conviction of ten (10) defendants, who have received prison sentences ranging from 18 to 99 months. (7)
United States v. Kerry L. Kaley, Case No. 05-80199-CR-Ryskamp, On November 30, 2005, the United States Attorney's Office filed a criminal Information against defendant Kerry Kaley, charging her with engaging in offenses related to the sale and transportation in interstate commerce of stolen prescription medical devices over the seven-year period from 1998 through February 2005 and seeking a forfeiture of approximately $1.4 million in illegal profit. On November 18, 2005, the United States Attorney’s Office filed two separate Informations, charging defendants Troy Guzman and Frank Tarsia with various offenses regarding the theft and diversion of prescription medical devices used in surgical procedures. On November 15, 2005, agents arrested Les Burns and co-defendant Joseph Gentile in Connecticut on a Complaint. Burns and Gentile were charged with conspiracy to traffic in stolen prescription medical devices and impeding the lawful functions of the United States Food and Drug Administration. These five defendants are the latest of twenty (20) defendants prosecuted in connection with Operation Miami Device, an investigation conducted by the FDA-OCI. In the past year, fifteen (15) defendants have been convicted in connection with this investigation, which as resulted in fines, forfeitures, and restitution orders exceeding $3.1 million. Assistant United States Attorney Thomas Watts-FitzGerald has prosecuted all cases arising from this investigation. (8) United States v. Luis Guevara, et al., Case No. 05-20860-CR-Jordan. On November 18, 2005, the United States Attorney’s Office filed an Information charging defendants Luis Guevara and Danatech Medical Systems, Inc. with smuggling medical devices into the United States by falsely claiming on paperwork that the devices were solely for use in veterinary applications. According to the Information, the devices were in intended for and used in the treatment of humans and were never submitted for market pre-certification by the FDA, as required by federal law. This case was investigated by the FDA-OCI and is being prosecuted by Assistant United States Attorney Thomas Watts-FitzGerald. (9) United States v. Luis Aceituno, Case No. 05-20852-CR-Lenard. On November 22, 2005, defendant Luis Aceituno pled guilty to an Information charging him with conspiracy to distribute prescription drugs without a valid wholesale distributor’s license. The Information was filed on November 17, 2005. Aceituno is scheduled to be sentenced on February 1, 2006. The FDA-OCI investigated this matter and the case is being prosecuted by Assistant United States Attorneys Eduardo I. Sanchez and E.J. Yera. (10) United States v. Yolanda Lobo, Case No. 05-80187-CR-Ryskamp. On November 8, 2005, the United States Attorney’s Office filed an Information charging defendant Yolanda Lobo, a licensed physician, with making false statements to Medicare in certificates of medical necessity to support the Medicare payment for motorized wheelchairs. This matter was investigated by the FBI and HHS-OIG and is being prosecuted by Assistant United States Attorney Robert N. Nicholson. (11) United States v. Rafael Walled, et al., Court Case No. 05-3400-Klein. On November 17, 2005, Federal Bureau of Investigation Special Agents arrested Rafael Walled and co-defendant Gregory Delatour on a Complaint charging them with conspiracy to violate the federal “anti-kickback” statute. This statute prohibits the payment and receipt of kickbacks and bribes in connection with referrals and services to Medicare patients. According to the Complaint, both defendants at various times earlier this year made cash payments to an FBI informant in connection for alleged medical treatments at a Miami medical clinic. These treatments were never performed. A trial date has not been set yet. The case is being prosecuted by Special Assistant United States Attorney William Parente. (12) United States v. AC Medical Center, Inc., Case No. 05-22659-CIV-Moreno. On November 17, 2005, the U.S. Attorney’s Office successfully obtained a preliminary injunction against AC Medical Center. The injunction followed a civil complaint filed by the United States Attorney’s Office on October 6, 2005, charging that AC Medical Center was paid $4.8 million by Medicare for medical services that had never been prescribed or performed by the supposed treating physician. Approximately $1 million in alleged fraud proceeds had previously been frozen as a result of a temporary restraining order previously issued by the Court. The allegedly fraudulent claims had been submitted during a 15-day period in April 2005 and were for costly AIDS/HIV treatments. The Federal Bureau of Investigation investigated this matter, which is being handled by Assistant United States Attorney Mark A. Lavine. United States Attorney Acosta urged anyone with information regarding possible health care fraud to contact the Department of Health and Human Services at their toll free fraud hotline, 1-800-HHS-TIPS. |