Three S. Fla. Fraud Schemes Derailed by Strike Force
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
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.
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