Three Miami-Area Residents Sentenced to Prison for Participating in $22 Million Medicare Fraud Scheme Involving Home Health Agencies

WASHINGTON—Three Miami-area residents were sentenced to prison today for their participation in a $22 million Medicare fraud scheme operated through two Miami home health agencies, ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., announced the Departments of Justice and Health and Human Services (HHS). A fourth individual was sentenced to home detention and supervised release for his participation in the scheme.

All four defendants were sentenced by U.S. District Court Judge Alan S. Gold in Miami.

Alejandro Hernandez Quiros, 33, was sentenced to 78 months in prison and three years of supervised release;

Vicenta Tellechea, 64, was sentenced to 69 months in prison and three years of supervised release;

Carlos Castaneda, 44, was sentenced to 40 months in prison and three years of supervised release; and

Javier Zambrana, 25, was sentenced to three years of probation, including 12 months of home detention.

Tellechea, Castaneda, Quiros, and Zambrana each pleaded guilty in 2009 to one count of conspiracy to commit health care fraud. In addition, Tellechea pleaded guilty to one count of paying kickbacks and Quiros pleaded guilty to three counts of paying kickbacks.

According to court documents, Quiros was a part owner of ABC. Quiros admitted that in addition to his ownership interest in ABC, he was also a patient recruiter for the agency and agreed to recruit Medicare beneficiaries for the purpose of billing the Medicare program for physical therapy and home health care services that were not medically necessary and/or were not provided. Quiros admitted to paying kickbacks and bribes to the Medicare beneficiaries whom he recruited. He also admitted that ABC fraudulently billed more than $17 million to the Medicare program and that Medicare paid more than $11 million of those claims.

Castaneda admitted in his plea hearing that he recruited Medicare beneficiaries for ABC and Florida Home Health by offering kickbacks and bribes in return for the beneficiaries’ information, which was used to fraudulently bill the Medicare program for unnecessary home health and therapy services. Castaneda also admitted that during his participation in the scheme, fraudulent billings to the Medicare program totaled more than $5.5 million for Florida Home Health. Medicare paid more than $4 million of those claims to Florida Home Health.

According to court documents, Tellechea was a part owner of Florida Home Health. She was responsible for approximately $4 million in intended losses to the Medicare program. At her plea hearing, Tellechea admitted that from October 2007 through March 2009, she engaged in a conspiracy to defraud Medicare that involved billing the Medicare program for home health and therapy services that were medically unnecessary and often times not provided. Tellechea further admitted that she established and took control of Florida Home Health along with her co-conspirators for the purpose of defrauding the Medicare program.

Zambrana was the nominee owner of ABC from approximately January 2006 through August 2007. Zambrana admitted that he signed documents and Medicare provider applications for ABC, purporting to be the true owner of the agency, when the true owners were in fact his parents, Gladys Zambrana and Enrique Perez. On Nov. 13, 2009, Gladys Zambrana and Perez pleaded guilty for their participation in the scheme and are scheduled to be sentenced next month.

In conjunction with the criminal case, on June 24, 2009, the U.S. Attorney’s Office for the Southern District of Florida filed a civil complaint for injunctive relief under the fraud injunction statute and obtained a temporary restraining order freezing the assets of ABC, Florida Home Health, Gladys Zambrana, Javier Zambrana, Perez, Quiros, Castaneda and Tellechea. A final default judgment was entered against ABC and Florida Home Health in August 2009 and against the other individuals in December 2009.

Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (OIG), Office of Investigations Miami office.

The criminal case is being prosecuted by Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section. The civil case was handled by Assistant U.S. Attorney Ted Radway of the U.S. Attorney’s Office for the Southern District of Florida. The case was investigated by the FBI and the Department of Health and Human Services (HHS), Office of Inspector General.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals who collectively have falsely billed the Medicare program for more than $1.85 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.