Fraud Strike Force Yields 38 Arrests in South Florida

WASHINGTON–Thirty-eight DME and infusion therapy providers have
been arrested and $142 million in billing fraud uncovered by a
Medicare Fraud Strike Force formed in south Florida, Attorney
General Alberto Gonzales and HHS Secretary Michael Leavitt
announced Wednesday.

In the first phase of the operation, investigations begun in
March have resulted in charges including conspiracy to defraud the
Medicare program, criminal false claims and violations of
anti-kickback statutes, Leavitt said. If convicted, many of the
defendants could get up to 20 years in prison.

According to a release from the Department of Justice, federal
agents arrested 24 people Tuesday, concluding a sweep of DME
company owners in southern Florida who were part of an alleged
fraudulent prescriptions scam. That brought the total number of
arrests under the strike force, which has so far focused only on
DME and infusion, to 38.

Officials said a variety of schemes included dispensing
unneccessary compounded aerosol meds rather than less expensive
commercial pharmaceuticals. In one example, Eduardo Moreno, the
owner of several DME companies, was arrested April 7 after being
named in a six-count fraud indictment. Two of Moreno’s companies,
Brenda Medical Supply and Faster Medical Equipment, allegedly
billed Medicare for more than $1.9 million for medically
unnecessary services.

The FBI has seized some of Moreno’s assets, including a
Rolls-Royce Phantom worth approximately $200,000.

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

Officials also said seizure warrants have been used to take
money back from bank accounts associated with some of the schemes.
In one case, agents from the HHS Office of Inspector General
recovered more than $1.2 million from a corporate bank account
after arresting Leider Alexis Munoz, president and CEO of RTC of
Miami, an infusion clinic in Hialeah, Fla.

The strike force, a multi-agency team of investigators,
identifies potential fraud cases through real-time analysis of
billing data from the Medicare Program Safeguard Contractors and
Health Care Information System claims data. It is part of a
multi-phase enforcement and regulatory effort to “improve the
quality of the industry and reduce the potential for fraud,”
according to the DOJ release. Additional measures include
strengthening the requirements to become a provider and increasing
scrutiny of existing providers.

“This initiative targets those who steal taxpayer funds intended
to provide health care to the elderly,” Gonzales said. The
real-time access to billing data, he added, allows officials “to
move quickly to make arrests and bring prosecutions as quickly as
possible. With better tools and information-sharing, we can expect
greater levels of enforcement.”

Leavitt called the strike force “just one weapon in our arsenal”
against fraud.

“We will be announcing the second step in this multi-year
process within the next month,” he said. “We expect industry
leaders will embrace the changes that will improve the quality of
the durable medical equipment industry and others who serve our
Medicare beneficiaries.”

In an effort to send “a strong message” to potential criminals,
Leslie Norwalk, CMS acting administrator said the agency has opened
two satellite offices dedicated to combating fraud in high-risk
areas with a third on the way.

The strike force teams, each led by a federal prosecutor with
agents from the FBI, HHS OIG and local law enforcement, operate out
of the federal Health Care Fraud Facility in Miramar,
Fla.