LAWFUEL – The Legal Newswire – The owner and operator of a Florida HIV infusion clinic and durable medical equipment company has pleaded guilty to engaging in a scheme to defraud the Medicare Program of more that $15 million, U.S. Attorney R. Alexander Acosta of the Southern District of Florida and Assistant Attorney General Alice S. Fisher of the Criminal Division announced today.
On September 26, 2007, Simon Seruya pleaded guilty to a superseding information charging him with one count of conspiracy to defraud the United States and to commit federal offenses (18 U.S.C. § 371) and one count of conspiracy to commit health care fraud (18 U.S.C. § 1349), stemming from schemes to defraud the Medicare Program of more than $15 million. The superseding information also seeks criminal forfeiture (18 U.S.C. § 982).
From approximately April 2001 through September 2004, Seruya submitted and caused the submission of approximately $15.3 million worth of fraudulent claims to the Medicare Program through an HIV infusion clinic that he owned and a durable medical equipment company that he owned. From approximately September 2001 through September 2004, Seruya owned and operated Bedat Management, Inc. (“Bedat Management”), a company that purported to specialize in treating HIV patients. During this time, Seruya submitted approximately $14.3 million worth of fraudulent claims to the Medicare program for medical treatments that were not actually provided to HIV patients and for treatments that were not medically necessary. Additionally, from approximately April 2001 through June 2003, Seruya owned and operated Medical Respiratory Equipment, Inc. (“Medical Respiratory”), a company that purported to provide respiratory and other durable medical equipment (“DME”) to Medicare beneficiaries.
During this time, Seruya paid kickbacks to Medicare beneficiaries in return for use of their Medicare numbers. Seruya would refer those Medicare beneficiaries to Lily’s and Unimed pharmacies so that those pharmacies could obtain reimbursement from Medicare for “compounded” aerosol medications that were not medically necessary. In return for referring these beneficiaries, Lily’s and Unimed paid cash kickbacks to Seruya of approximately fifty percent of the Medicare payments that Lily’s and Unimed received for each prescription. Seruya also billed Medicare for related unnecessary respiratory equipment through Medical Respiratory. In total, Seruya submitted and caused the submission of approximately $1 million worth of fraudulent claims through Lily’s, Unimed, and Medical Respiratory.
United States Attorney Acosta stated, “HIV and other infusion fraud, along with the provision of medically unnecessary services, not only drain on scarce Medicare resources, but can present serious risks to the safety and welfare of patients. We stand committed to stopping these abuses through aggressive prosecutions.”
A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls . Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on .
