MIAMI — The owner of 13 South Florida DME companies and three clinics pleaded guilty to criminal charges in connection with a Medicare scheme involving nearly $57 million in false claims, federal prosecutors announced Nov. 14.
According to a statement from R. Alexander Acosta, U.S. attorney for the Southern District of Florida, defendant Miguel Almanza and his co-conspirators concealed their control of the DME companies and clinics, located in Miami-Dade and Hillsborough counties, by recruiting "nominee" or "straw owners," who were typically paid a percentage of the fraud proceeds to sign the necessary corporate records and Medicare applications.
"Notably, Almanza often recruited family members or recent immigrants from his hometown of Moron, Cuba, to serve as the nominee owners of his DME companies," the statement said.
The companies submitted $56.7 million in false claims for medical equipment including nebulizers, oxygen concentrators, powered air mattresses and wheelchairs.
In the scheme, Almanza purchased the identities of beneficiaries and used their Medicare numbers to submit the claims. During the early years of the conspiracy, Almanza and his partners paid monthly cash kickbacks to these "professional patients" so they would not report the false claims to Medicare, according to the statement.
But over time, "the scheme changed because Almanza and his partners found it cumbersome to pay kickbacks to dozens of patients. Consequently, Almanza and his partners began to purchase stolen patient identities from patient recruiters and billing companies."
Once Medicare paid the false claims, some proceeds were laundered by distributing pre-signed corporate checks, often for amounts just under $10,000, to a network of so-called "check cashers," who were paid a typical 10 percent commission to cash the checks at local banks.
Under a second laundering scheme, nominee owners were recruited to open various sham corporations, including construction companies and investment firms. The Medicare proceeds were deposited into those companies' bank accounts and then later distributed to Almanza and his partners, the statement said, adding: "Almanza used the fraud proceeds to purchase a home, luxury cars and to finance other lavish personal expenditures. Almanza also used the funds for gambling at various South Florida casinos, where he often spent more than $10,000 per night."
Almanza faces a maximum 10-year prison term for the Medicare conspiracy, and five years for making false claims upon the United States.
View a list of the DME companies involved.
The scheme follows another $17 million South Florida fraud case that kept things all in the family.
According to a statement from Acosta, defendants David Hernandez and his wife Laura Hernandez of Pembroke Pines, Fla., began defrauding Medicare as early as 1999 when they opened two DME companies, Florida DME and On-Time Medical Equipment Rentals, and used them to submit $5.9 million of false claims. Laura Hernandez then formed Triple AAA Billing, which processed and submitted the companies' electronic claims.
In 2003, David Hernandez expanded the scheme when he opened SOS DME with co-defendant Magaly Martinez, the receptionist at On-Time Medical. Later, Hernandez opened additional DME companies with three of Martinez' family members, including YYS Medical Supply with Martinez' son, defendant Yuniel Echevarria; All County Medical Equipment with Martinez' husband, defendant Jose Echevarria; and Tri-County Medical Supplies with Martinez' daughter-in-law, defendant Suyima Torres. These four DMEs submitted another $11.3 million in false Medicare claims that were processed by Laura Hernandez' company, Triple AAA Billing.
David Hernandez' brother, defendant Jose Miguel Hernandez, helped to promote the scheme and conceal the false claims by delivering kickbacks "to a vast network of 'professional patients' who were paid to sell their Medicare cards," the statement said. "When Jose Miguel Hernandez visited each patient's home, he would instruct them to sign 'delivery receipts,' which created the appearance that the patients had received durable medical equipment. In fact, howver, the patients did not receive any equipment. After the patients signed the necessary forms, Hernandez would pay them cash, often $200 to $300 per visit."
David Hernandez, Laura Hernandez, and Jose Miguel Hernandez face a maximum of 10 years in prison on the Medicare fraud offenses.
In separate cases in July, co-conspirators Magaly Martinez, Jose Echevarria, Yuniel Echevarria and Suyima Torres pled guilty to Informations charging them each with one count of conspiracy to commit health care fraud.