LAWFUEL – The Law Newswire – United States Attorney R. Alexander Aco…

LAWFUEL – The Law Newswire – United States Attorney R. Alexander Acosta, Leslie V. Norwalk, Acting Administrator of the Centers for Medicare and Medicaid Services, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, and Melody Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office, announced today the results of a multi-agency effort to prosecute individuals and health care companies that fraudulently bill the Medicare program. On May 8, 2007, the U.S. Attorney’s Office charged twenty-four (24) individuals with Medicare fraud. Today, four additional individuals were arrested in a separate health care fraud scheme. This brings the total number of defendants charged to date to forty-two (42).

The arrests in the Southern District of Florida are the result of the establishment of a multi-agency task force of federal, state and local investigators designed specifically to combat Medicare fraud through the use of real-time analysis of Medicare billing data. Since the first phase of strike force operations began on March 1, 2007 in Southern Florida, the strike force has indicted 34 cases that have collectively billed the Medicare program for $142,061,059. Charges brought against the thirty-eight defendants include conspiracy to defraud the Medicare program, criminal false claims, and violations of the anti-kickback statutes. If convicted, many of the defendants face up to 20 years in prison on these charges.

The strike force is able to identify potential fraud cases for investigation and prosecution quickly through real-time analysis of billing data from Medicare Program Safeguard Contractors (PSCs) and claims data extracted from the Health Care Information System. In phase one operations in Miami, thirty four fraud indictments have been returned against infusion therapy and durable medical equipment (DME) suppliers.

The work of the Medicare fraud strike force is one step in a multi-phase enforcement and regulatory project designed to improve the quality of the industry and reduce the potential for fraud in the durable medical equipment and infusion areas. The Centers for Medicare and Medicaid Services is taking steps to increase accountability and decrease the presence of fraudulent providers. The end result will be better service to beneficiaries and savings of billions of dollars that might otherwise go to fraudulent businesses.

According to Acosta, the Strike Force is supplementing the ongoing health care fraud enforcement efforts of the United States Attorney’s Office in the Southern District of Florida, which has been among the leading offices in combating health care fraud nationwide. Since announcing a federal-state health care fraud initiative in December 2005, the United States Attorney’s Office has filed more than 130 criminal cases charging nearly 200 defendants with federal violations in various health care fraud schemes and significant civil cases, enforcement actions, and settlements. Collectively, defendants and subjects billed the Medicare program $300 million and received more than $150 million in reimbursements in cases that preceded the Strike Force prosecutions announced today. The vast majority of these cases involved fraudulent DME or HIV infusion fraud schemes.

U.S. Attorney Acosta added, “Eighteen months ago, the U.S. Attorney’s Office in the Southern District of Florida implemented a health care fraud task force to fight fraud and abuse in our community. Our involvement in today’s multi-agency anti-fraud effort is a critical part of our continuing resolve to safeguard the integrity of the Medicare program by stopping fraud and abuse on a real-time basis, particularly in cases of durable medical equipment and infusion therapy frauds.”

“CMS is taking innovative and aggressive approaches to address the fraud that has been occurring in South Florida,” said Leslie V. Norwalk, Esq., Acting Administrator of the Centers for Medicare and Medicaid Services. “These advances allow CMS to work more effectively with beneficiaries. Just as significant, our efforts facilitate law enforcement’s ability to identify more quickly those providers who seek to harm the Medicare program and to prevent them from enrolling or to terminate their participation in Medicare.”

FBI Special Agent in Charge Jonathan I. Solomon stated, “The stability and strength of the Medicare system is imperative if this valuable program is to continue to exist for the benefit of future generations. The Strike Force will help us preserve the integrity of the Medicare program through the speedy prosecution of those who commit fraud. With our federal and local law enforcement partners, we will continue to combat fraud on the Medicare program.”

Melody Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office, stated, “The Medicare Fraud Strike Force is a cooperative and proactive law enforcement effort to address fraud, waste and abuse in South Florida. My office is committed to serving the public in combating this fraud.”

On the morning of May 8, 2007, federal agents arrested 24 people associated with pharmaceutical frauds. The defendants charged participated in schemes to bill Medicare for expensive inhalation medications. They are alleged to have provided pharmacists fraudulent prescriptions for compounded aerosols. These are expensive, custom-made medications, which are supposed to be used only when necessary to treat particularized medical needs. Here, they were not used to treat any patients. In fact, the compounding of medication was done solely to defraud Medicare, and one of the men mixing the medications was not a licensed pharmacist, but rather an air-conditioner repairman. When the medicines were prepared, they were typically thrown in the garbage. The fraudulent prescriptions in these cases totaled more than $14 million.

Other indictments brought by the Strike Force outline various types of fraudulent schemes. In one case, defendant Eduardo Moreno, the owner of multiple DME companies, was arrested on April 7 after being named in a six-count fraud indictment. Two of Moreno’s companies – Brenda Medical Supply, Inc., and Faster Medical Equipment, Inc. – allegedly billed Medicare for more than $1.9 million for services that were not medically necessary. The FBI has seized of some of Moreno’s assets, including a new Rolls Royce Phantom worth approximately $200,000.

In another indictment, Barbara Diaz and Jose Prieto were charged with conspiring to defraud Medicare, submitting false claims to Medicare and money laundering. The indictment further alleges that Diaz and Prieto engaged in an infusion therapy scheme, where patients did not need the drugs that were purportedly used. From March 9 through December 31, 2006, the defendants billed Medicare for over $900,000 for infusion.

Seizure warrants have been used to take money back from bank accounts associated with the health care fraud activity alleged in the indictments. In one case, agents recovered more than $1.2 million from a corporate bank account after arresting Leider Alexis Munoz, the president and chief executive officer of RTC of Miami, Inc., an infusion clinic located in Hialeah, Florida.

The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida. Each team has four to six agents, at least one agent from the FBI and HHS Office of Inspector General, as well as representatives of local law enforcement. The teams operate out of the federal Health Care Fraud Facility in Miramar, Florida.

Mr. Acosta commended the investigative efforts of the Centers for Medicare and Medicaid Services, Federal Bureau of Investigation, and the U.S. Department of Health and Human Services. The operation is being prosecuted by attorneys from the Criminal Division’s Fraud Section and the Major Crimes Section of the U.S. Attorney’s Office for the Southern District of Florida. In addition to federal agents, the teams have officers and detectives from the Florida Medicaid Fraud Control Unit and Hialeah Police Department.

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 http://pacer.flsd.uscourts.gov.

MEDICARE FRAUD STRIKE FORCE

PHASE ONE – INDICTMENTS

MARCH 1, 2007 – MAY 3, 2007

1. US vs. Raul Paula, 07-20285-CR-HUCK

2. US vs. Domingo Santa, et al., 07-20282-CR-UNGARO

3. US vs. Yosmanys Gonzalez, et al., 07-20289-CR-MARTINEZ

4. US vs. Lazaro Salaz Uvino, 07-20290-CR-GOLD

5. US vs. Luis Lopez, 07-20270-CR-SEITZ(s)

6. US vs. Gisela Valladares, 07-20355-CR-MOORE

7. US vs. Silvia Pita, 07-20284-CR-JORDAN

8. US vs. Simon Seruya, 07-20268-CR-COOKE

9. US vs. Marianela Smith, 07-20283-CR-LENARD

10. US vs. Rolando Senti, 07-20276-CR-MARTINEZ

11. US vs. Moreno, et al., 07-2-256-CR-LENARD

12. US vs. Luis Soto, 07-20278-CR-COOKE

13. US vs. Fermin Rey, 07-20267-CR-KING

14. US vs. Jhon Salazar, 07-20281-CR-GOLD

15. US vs. Roberto Sanchez, 07-20287-CR-MOORE

16. US vs. Rodolfo Aenlle, 07-20271-CR-MIDDLEBROOKS

17. US vs. Miguel Almanza, 07-20273-CR-ALTONAGA

18. US vs. Pedro Becerra, 07-20272-CR-MOORE

19. US vs. Orlando Pascual, 07-20274-CR-HUCK

20. US vs. Leider Munoz, 07-20225-CR-UNGARO

21. US vs. Lazaro Lemus, 07-20279-CR-GRAHAM

22. US vs. Susana Luciani, 07-20269-CR-MARTINEZ

23. US vs. Noel Rodriguez, 07-20277-CR-KING

24. US vs. Exlan Arias, 07-20266-CR-ALTONAGA

25. US vs. Rosa Ginart, 07-20286-CR-GRAHAM

26. US vs. Barbara Diaz, et al., 07-20177-CR-LENARD

27. US vs. Luis Delgado, 07-20180-CR-UNGARO

28. US vs. Georgeana Pastrana, 07-20280-CR-LENARD

29. US vs. Ana Maria Perez, 07-20292-CR-SEITZ

30. US vs. Nelson Valdes, 07-20288-CR-ALTONAGA

31. US vs. Maria De La Serna, 07-20275-CR-COOKE

32. US vs. Ifrain Ferreiro, 07-20265-CR-GRAHAM

33. US vs. Maria Hernandez, 07-20291-CR-COOKE

34. US vs. Reyselda Vasquez, 07-20354-CR-SEITZ

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