22 September – LAWFUEL – The Law News Network – R. Alexander Acosta, United States Attorney for the Southern District of Florida, Michael S. Clemens, Special Agent in Charge of the Federal Bureau of Investigation, Linda S. Little, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General, and Enrique Gutierrez, Postal Inspector in Charge, United States Postal Inspection Service, Miami Division, announced today the sentencing of two doctors convicted in March 2005 of conspiring to participate in a multi-million health care fraud scheme.
Finding that doctor Jose A. Garrido had caused a loss to Medicare in the amount of $416,741 and losses to private insurance companies of $163,345, U.S. District Court Judge Adalberto Jordan sentenced Garrido to thirty-three (33) months in prison, followed by two (2) years of supervised release. Judge Jordan further ordered that Garrido pay restitution to the Center for Medicare/Medicaid Services in the amount of $416,741. A restitution hearing to determine the amounts to be paid to the private insurance companies is scheduled for November 10, 2005.
The second doctor, Edgard Zamora, was found by Judge Jordan to have caused a loss to Medicare in the amount of $135,190 and losses to private insurance companies in the amount of $120,459. Based on this fraud loss, Judge Jordan sentenced Zamora to twenty-seven (27) months in prison to be followed by two (2) years supervised release. Judge Jordan postponed announcing restitution owed by Zamora, and will hold a hearing on the matter also on November 10, 2005.
Both doctors are to surrender to the Bureau of Prisons on December 2, 2005 to begin service of their sentences.
As shown at trial, from 1997 to 2002, Heldy Artiles and her husband, Orlando Artiles, Jr., conspired with physicians, a physician’s assistant, physical therapists, and others to fraudulently bill Medicare and private insurance companies for approximately $5.5 million of medical services, medical equipment, medications, and physical therapy that was either not provided or was medically unnecessary. The physicians convicted in the trial were Jose Garrido and Edgard Zamora. Also convicted was the office manager, Dalia Fernandez, and two patient recruiters, Antonio Piña and Deisy Aviles. Since being charged, the following people pled guilty: Heldy Artiles, Orlando Artiles, Jr., Elva Monteagudo, Heldy Artiles’ mother; Guillermo Garcia, a physician; Alberto Exposito, a physician’s assistant; Noelia Davila and Dulce Suarez, physical therapists; and clinic employees Dafne Mesa, Elayne Sanchez, Carmen Arelis Pichardo, Margarita Campos; and patient recruiters James Lyons, Candelaria Alvarez, Olga Gonzalez, and Tomas Del Coral.
The scheme involved Miami Health Medical Center (Miami Health), a Miami medical clinic; Exclusive Medical Supply, Inc., and Hope Medical Supplies, Inc., Miami durable medical equipment companies; and Ideal Pharmacy, a Miami pharmacy. As shown at trial, the Artileses and their co-conspirators paid kickbacks to Medicare beneficiaries to serve as patients of Miami Health and the other three medical companies. For each of the patients, Heldy Artiles and several co-defendants falsified doctors’ notes and patient medical records, adding false patient complaints, fabricating diagnoses and treatment plans, and ordering unnecessary tests, medications, equipment, and physical therapy.
Doctors Garcia, Zamora, and Garrido, who worked at various times at Miami Health, signed and approved altered medical records and fraudulent prescriptions, knowing, in some instances, that the underlying patient office visits had never occurred and otherwise knowing that unnecessary medical services, medications, equipment, and physical therapy were being ordered. Then, based on the altered and falsified records, Miami Health, Exclusive Medical Supply, Hope Medical Supply, and Ideal Pharmacy then submitted claims to Medicare for reimbursement.
On other occasions, the conspirators staged automobile accidents, paying bribes to the supposed victims to get them to complain of non-existent injuries when they went to Miami Health. Based on the falsified injuries, Miami Health then submitted fraudulent claims to automobile insurance companies to be paid for the cost of medically unnecessary physical therapy, which was allegedly performed at the medical clinic.
With the sentencing of the doctors, all twenty (20) defendants charged in the health care fraud scheme have been convicted and sentenced. Their sentences are as follows:
Heldy Artiles and Orlando Artiles, 87 months in prison;
Elva Monteagudo, 37 months in prison;
Guillermo Garcia, 24 months in prison;
Alberto Exposito, 14 months in prison;
Dalia Fernandez, 66 months in prison;
Dafne Mesa, 12 months and 1 day in prison;
Elayne Sanchez, 24 months in prison;
Margarita Campos, 12 months and 1 day;
Arelis Pichardo, 18 months in prison;
Noelia Davila, 21 months in prison;
Dulce Suarez, 18 months in prison;
Antonio Piña, 41 months in prison;
Deisy Aviles, 41 months in prison;
Olga Gonzalez, 24 months in prison;
Tomas Del Coral, 27 months in prison;
James Lyons, 2 years probation, 6 months home confinement;
Candelaria Alvarez, 6 months in prison.
In September 2003, the United States Attorney’s Office filed a civil suit against the Artileses, Monteagudo, Garcia, and Lucia Sanchez, an associate of the Artileses, seeking to freeze proceeds of the health care fraud. United States District Judge Adalberto Jordan subsequently granted the government’s request for an injunction to temporarily freeze various assets, including Artiles real estate.
Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation, the United States Department of Health and Human Services, Office of Inspector General, the United States Postal Inspection Service, and the National Insurance Crime Bureau, of Plantation, Florida. The criminal case was prosecuted by Assistant United States Attorneys Joan Silverstein and Seth Miles. The civil injunctive lawsuit was handled by Assistant United States Attorney Mark A. Lavine.
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 .