Officials to Crack Down on Florida Fraud

Tampa, Fla.

State and federal law enforcement officials recently announced a joint effort to prosecute health care fraud perpetrators in South Florida, calling the region one of the worst for such crimes in the country.

“False billings, diversion of drugs and medical equipment and other types of health care fraud cost taxpayers millions of dollars annually,” said R. Alexander Acosta, U.S. Attorney for the Southern District of Florida. “More importantly, health care fraud endangers the health and well-being of our patients.”

Acosta announced the new initiative with Florida Attorney General Charlie Crist.

Since mid-June, the U.S. Attorney’s office has charged 64 defendants in 28 separate criminal cases totaling more than $20 million in losses for Medicare, Medicaid and other health insurance programs, Acosta said. In addition, the office’s civil division has obtained seven injunctions to freeze some $14 million in fraud proceeds.

But law enforcement officials have painted an even grimmer picture: Michael Clemens, FBI special agent in charge of the Miami field office, estimated that in 2004, health care fraud losses in southeastern Florida were $1 billion. And the FBI office in Miami has 30 agents working health care fraud cases: 100 active investigations representing $3 billion in losses.

“South Florida is ground zero for health care fraud,” Clemens said at a news conference about the initiative.

With the new joint initiative, officials also announced recently filed criminal charges against 20 health care fraud defendants in 12 separate cases, four involving durable medical equipment:

• Ahmed Pons, Santos Infante, Juan Carlos Olive, Diomar Ortega, and Sergio Ortega are charged with a scheme to defraud Medicare through the submission of false claims concerning Miami-area DMEs;
• Antonio Hevia allegedly recruited and paid kickbacks to Medicare patients for access to their patient identification information, which several Miami DMEs used to submit fraudulent claims to Medicare;
• Miguel Ugarte, an orthotist, allegedly was paid to sign forms indicating that he had fit Medicare patients for specialized orthotic equipment, for which Medicare was fraudulently billed by various Miami DMEs; and
• Yolanda Lobo, a physician, is charged with making false statements to Medicare in certificates of medical necessity to support the Medicare payment for power wheelchairs.