Two South Florida Residents Plead Guilty in Medicare Fraud Cases

WASHINGTON – Two South Florida residents pleaded guilty today in U.S. District Court in Miami for their participation in separate Medicare fraud schemes, announced the Departments of Justice and Health and Human Services (HHS). Both individuals worked for Miami health care companies that billed the Medicare program for services that were medically unnecessary or never provided.

Gladis Badia, 40, pleaded guilty before U.S. District Court Judge Adalberto Jordan to one count of conspiracy to defraud the United States, to cause submission of false claims to Medicare, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims, as charged in a March 2010 indictment. In a separate case, Alain Fernandez, 47, pleaded guilty before Judge Jordan to one count of conspiracy to commit health care fraud and one count of making false statements in patient files.

According to court documents, Badia was employed by T&R Rehabilitation Professional Corp., a Miami clinic that purported to provide injection and infusion treatments to patients with HIV. Badia admitted that she created and entered false information into patient files to make it appear that patients qualified for services, when in fact, they did not. According to court documents, Badia knew Medicare would be fraudulently billed for the purported services. Badia admitted that she knew the patients did not qualify for and in some instances did not receive the HIV infusion services, and that her co-conspirators could bill Medicare for HIV infusion services three times a week, for up to three months, for each patient. Badia also admitted that the conspiracy resulted in over $13.7 million in fraudulent billing to the Medicare program.

In a separate case, Fernandez admitted that he worked for Florida Home Health Providers Inc., a Miami home health agency that purported to provide home health and therapy services to Medicare beneficiaries. Fernandez, a licensed practical nurse, admitted that he falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services, when in fact, the beneficiaries did not qualify for and did not receive the services. Fernandez admitted that he did so in agreement with his co-conspirators so that the Medicare program could be billed for medically unnecessary services. Fernandez further admitted that as a result of his role in the scheme, Medicare was billed approximately $43,000 for purported home health care services that were not medically necessary and/or were not rendered.

Badia and Fernandez are scheduled to be sentenced on Nov. 12, 2010. Badia faces a maximum penalty of five years in prison for the conspiracy to defraud the United States count and for each false claims count, and 10 years in prison for the health care fraud conspiracy count. Fernandez faces a maximum penalty of 10 years in prison for the health care fraud conspiracy count and 5 years in prison for the false statement count.

Today’s guilty pleas 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 (HHS-OIG), Office of Investigations Miami office.

The cases are being prosecuted by Trial Attorneys N. Nathan Dimock, Joe Beemsterboer, Sam Sheldon and Henry Van Dyck, former Trial Attorney Michael Padula and former Special Trial Attorney Martha Talley of the Criminal Division’s Fraud Section. The cases were investigated by the FBI and HHS-OIG, and were brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s 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.