The Justice Department announced today a significant health
care fraud enforcement operation across Florida and Georgia, involving charges
against a total of 67 individuals across four federal districts for their
alleged involvement in various schemes to defraud Medicare and Medicaid. The conduct allegedly resulted in more than
$160 million in fraudulent billings.
Those charged included physicians as well as other medical and business
professionals. In addition, in the state of Florida, 16 defendants, including
one licensed mental health professionals, have been charged with defrauding the
Medicaid program out of over $1.2 million.
Florida’s Medicaid Fraud Control Unit (MFCU) investigated these cases.
The charges announced today aggressively target schemes
alleged to have billed Medicare, Medicaid and private insurance companies for
medically unnecessary services, such as home health, prescriptions drugs and
durable medical equipment.
Today’s enforcement actions were led and coordinated by the
Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction
with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the
Criminal Division, U.S. Attorney’s Offices, the FBI and U.S. Health and Human
Services-Office of Inspector General (HHS-OIG).
In addition, the operation includes the participation of various other
federal law enforcement agencies and state MFCUs. The Centers for Medicare
& Medicaid Services, Center for Program Integrity (CMS/CPI) also announced
today that all appropriate administrative actions would be taken based on these
charges.
“The defendants charged today allegedly bilked the American
people to the tune of millions in fraudulent billings,” said Assistant Attorney
General Brian A. Benczkowski of the Justice Department’s Criminal
Division. “All Americans should stand
with the Department as we fight the fight against these unscrupulous schemes in
Florida, Georgia, and across the country.”
“Anyone who seeks to exploit our federal healthcare programs
for personal gain and illicit profit should know that we will prosecute them to
the fullest extent of the law,” said U.S. Attorney Maria Chapa Lopez for the
Middle District of Florida. “The
American people must have confidence in the healthcare services for which they
pay and receive, and trust in those who administer them.”
“Health care programs provide vital services to Americans,”
said U.S. Attorney Ariana Fajardo Orshan of the Southern District of
Florida. “Those who perpetuate these
pervasive health care fraud schemes steal taxpayer dollars from intended
beneficiaries and threaten the viability of government programs. We commend the coordinated and continued
efforts of our federal law enforcement partners to root out fraud and abuse in
our healthcare system.”
“The drug dealer stereotype involves violent gang members peddling
poison in our streets, but often the illicit dealers wear white coats and work
in medical offices,” said U.S. Attorney Bobby L. Christine for the Southern
District of Georgia. “People who violate
medical oaths and ethical codes to turn illegal profits by fueling the opioid
crisis will find prosecutors and investigators working tirelessly to swap their
lab coats for prison uniforms.”
“Being a healthcare professional in the Medicare program is
a privilege, not a right. When
physicians and other healthcare providers put their own financial gain above
patient well-being and honest billing of government health programs, they
violate the basic trust that taxpayers extend to healthcare professionals,”
said Special Agent in Charge Derrick L. Jackson of the HHS-OIG Atlanta Regional
Office. “Today’s arrests put corrupt
medical professionals on alert that law enforcement will do everything possible
to root out all forms of waste, fraud and abuse in our federal health care
programs.”
“FBI Atlanta and its Savannah Resident Agency are proud to
have participated in this nationwide effort to help protect the much needed
federal funds that Medicare provides,” said Special Agent in Charge Chris
Hacker of the FBI’s Atlanta Field Office.
“When providers are driven by greed and abuse the Medicare program,
every tax paying citizen is a victim, especially those who use the federal
funds for their health care needs. Improper billing inflates costs and the FBI
and its law enforcement partners are determined to hold those who do it
accountable.”
“The FBI and its federal, state and local partners are
working tirelessly every day to detect and combat schemes like those announced
today,” said Special Agent in Charge George L. Piro of the FBI’s Miami field
office. “Despite our efforts, we still
need the public's help in reporting suspicious activity. If anyone suspects they are a victim of
health care fraud please call your local FBI office or the HHS Office of
Inspector General.”
“We commend the law enforcement partnerships for this
operation and pledge to continue our commitment to protecting the nation's
federally funded healthcare system and the people who depend on it," said
Special Agent in Charge Michael McPherson of the FBI’s Tampa Division.
*********
Among those charged in partnership between Strike Force
attorneys and U.S. Attorney’s Offices are the following:
In the Northern District of Georgia, one defendant was
charged.
Donald Graham, 49, of Smyrna, Georgia, a former employee of
a metro Atlanta hospital, has been charged for allegedly stealing and selling
individually identifiable health information that was used to submit fraudulent
claims to Medicaid. Assistant U.S.
Attorney Jeffrey A. Brown of the Northern District of Georgia and Assistant
Attorney General Elizabeth Grofic of the Georgia Medicaid Fraud Control Unit
are handling the case.
In the Southern District of Georgia, six defendants were
charged and one civil complaint was filed.
Jenna Savage, 26 of Port Wentworth, Georgia; Norman Lee
Burnsed, 27 of Port Wentworth, Georgia; Tucker Chambers, 21 of Ellabell,
Georgia; Macaila Brown, 22 of Rincon, Georgia; and Cameron Hilliard, 26 of
Savannah, Georgia, were indicted by a federal grand jury in Savannah with
conspiracy charges under the Controlled Substances Act relating to the
distribution of oxycodone, Adderall, alprazolam, and clonazepam. Assistant U.S.
Attorneys Katelyn Semales and Marcela Mateo are prosecuting the case.
David L. Williford, 59, of Rincon, Georgia, a pharmacist,
was charged by information with one count of acquiring a controlled substance
(oxycodone) by misrepresentation, fraud, or forgery. Assistant U.S. Attorney
Jonathan A. Porter is prosecuting the case.
Darien Pharmacy and Janice Ann Colter, 62, of Darien,
Georgia, a pharmacist, were named in a civil complaint filed in federal court
that accused Darien Pharmacy and Colter of filling prescriptions for controlled
substances that the defendants knew or should have known were not issued for
legitimate medical reasons, and by a provider not acting with the regular
course of professional practice. Assistant U.S. Attorneys Bradford C. Patrick
and Jonathan A. Porter are prosecuting the case.
In the Middle District of Florida, two defendants were
charged.
Teresa Johnson, 53, of Lecanto, Florida, was charged by
information with one count of conspiracy to commit health care fraud and submit
fraudulent claims to Medicare, Medicaid, Tricare and ChampaVA. According to the indictment, Johnson owned
and operated Tri-County Medical Billing and, from November 2016 through October
2018, knowingly submitted false and fraudulent claims on behalf of a medical
doctor who owned clinics in Crystal River, Spring Hill and Celebration,
Florida. HHS-OIG, FBI, DoD-OIG, VA-OIG and
the Florida Office of Attorney General Medicaid Fraud Control Unit investigated
the case. Assistant U.S. Attorney Kelley Howard-Allen is prosecuting the case.
Marcus Anderson, 34, of St. Petersburg, Florida, was charged
in a thirteen-count indictment with health care fraud and aggravated identity
theft for allegedly stealing rendering providers’ identities to submit more
than $1.2 million in false and fraudulent claims to Medicaid. HHS-OIG and the
Florida Office of Attorney General’s Medicaid Fraud Control Unit investigated
the case. Assistant U.S. Attorney Kristen A. Fiore will prosecute the case.
In the Southern District of Florida, 42 defendants were
charged.
Ana Maria Fernandez, 62, and Berta Leon, 69, of Miami,
Florida, were charged with conspiracy to defraud the U.S. and the solicitation
and receipt of kickbacks in connection with a federal health care program. According to the indictment, the defendants
participated in a conspiracy to use their company ABC Medical Solutions Corp.
of Miami, to solicit and receive kickback payments for the referral of Medicare
beneficiaries to home health agencies, including ACM Home Health Corp. of Miami
and TC Home Health Care Inc. of Hialeah, Florida. This case was investigated by HHS-OIG and the
FBI. Assistant U.S. Attorney Timothy J.
Abraham of the Southern District of Florida is prosecuting this case.
Sara Tania Ruiz, 55, of Hialeah, and Maria Laura Prieto, 60,
of Miami, were charged by indictment with conspiracy to defraud the U.S. and
the solicitation and receipt of kickbacks in connection with a federal health
care program. According to the
indictment, the defendants participated in a conspiracy to solicit and receive
kickback payments for the referral of Medicare beneficiaries to home health
agencies, including ACM Home Health Corp. of Miami and TC Home Health Care Inc.
of Hialeah. This case was investigated
by HHS-OIG and the FBI. Assistant U.S.
Attorney Timothy J. Abraham of the Southern District of Florida is prosecuting
this case.
Marisol Padilla, 48, of Hialeah, was charged by indictment
with conspiracy to defraud the U.S. and the solicitation and receipt of
kickbacks in connection with a federal health care program. According to the indictment, the defendant
participated in a conspiracy to solicit and receive kickback payments for the
referral of Medicare beneficiaries to TC Home Health Care of Hialeah. This case was investigated by
HHS-OIG and the FBI. Assistant U.S.
Attorney Timothy J. Abraham is prosecuting this case.
Juan Jose Mesa, 58, and Madelaine Varona, 47, both of Miami,
owners and/or operators of All Excellent OT-PT Service LLC of Miami and Cruz
Healthcare Corp. of Miami, respectively; Sandra Cardona, 47, of Hialeah, an
allegedly unlicensed therapist; and Silvia Salvatori, 67, of Pembroke Pines,
Florida, a licensed massage therapist, were charged by indictment with one
count of conspiracy to commit health care fraud and wire fraud. Mesa and Varona were also charged with five
and six counts of health care fraud, respectively. The charges stem from Mesa’s and Varona’s
alleged roles in a scheme to defraud Part A of the Medicare program of more
than $4 million by billing for home health services that were not rendered and
paying kickbacks to patient recruiters in exchange for patient referrals. Cardona and Salvatori, who were allegedly not
licensed to provide physical therapy, accepted payment from a licensed physical
therapist, paid by their co-conspirators, in exchange for allegedly obtaining
signed patient visitation forms from Medicare beneficiaries used to submit
false and fraudulent claims. This case
was investigated by HHS-OIG and the FBI.
The case is being handled by Assistant U.S. Attorney Kevin Larsen of the
Southern District of Florida.
Ivan Bejerano, 49, of Miami, was charged by indictment with
seven counts of health care fraud and one count of conspiracy to commit health
care and wire fraud. According to the
indictment, Dynamic Physical Rehab Inc. (Dynamic) was a Miami medical clinic
that purportedly provided private insurance beneficiaries with various medical
treatments and services. From June 2017 through July 2019, Bejerano allegedly
submitted and caused the submission of claims, via interstate wires, totaling
approximately $2.5 million that falsely and fraudulently represented that
various health care benefits, primarily physical therapy, were medically
necessary, prescribed by a doctor, and had been provided by Dynamic to
insurance beneficiaries of Blue Cross Blue Shield (BCBS). This case was investigated by the FBI. This case is being prosecuted by Assistant
U.S. Attorney Shannon Shaw of the Southern District of Florida.
Jocelyn De La Caridad Perez, 41, and Joaquin Guevara, 46,
both of Miami, were charged by indictment with one count of conspiracy to
receive health care kickbacks. Perez was
also charged with one count of conspiracy to commit health care fraud and wire
fraud, and Guevara was also charged with three counts of receipt of kickbacks
in connection with a federal health care program. According to the indictment, Perez was an
administrator of Joe Rehabilitation and Diagnostic, Inc. (Joe Rehab), an
outpatient rehabilitation facility in Doral, Florida, that purportedly provided
therapy services to Medicare beneficiaries.
As part of the fraudulent scheme, Perez allegedly conspired with others
to pay kickbacks and bribes for the referral of Medicare beneficiaries to Joe
Rehab so their information could be used to submit fraudulent claims to
Medicare for services purportedly provided, regardless of whether the Medicare
beneficiaries needed or received the services.
This case was investigated by HHS-OIG and the FBI. Assistant U.S. Attorney Anne P. McNamara of
the Southern District of Florida is prosecuting this case.
Deivys Ernesto Alvarez, 48, of Hialeah, was charged by
indictment with one count of conspiracy to commit health care fraud and wire
fraud and four counts of health care fraud.
According to the indictment, Alvarez was the owner of Diagnostic Center
of Medley Inc., a Miami medical clinic.
AP & JL Medical Center Inc. (AP & JL) was another Miami medical
clinic that purportedly provided private insurance beneficiaries with various
medical treatments and services. Alvarez
and co-conspirators allegedly recruited and paid Comcast Corp. and Telemundo
Corp. employees, through Diagnostic Center of Medley Inc., and referred those
employees and/or the employees’ personal information to AP & JL to
fraudulently bill BCBS. Alvarez and his
co-conspirators allegedly submitted and caused the submission of false and
fraudulent claims, via interstate wires, totaling approximately $800,500. This
case was investigated by HHS-OIG and the FBI.
This case is being prosecuted by Assistant U.S. Attorney Timothy J.
Abraham of the Southern District of Florida.
Elba Cobos Baile, 60, and Yolanda Castano, 55, both of
Miami, were charged by indictment with four counts of health care fraud and one
count of conspiracy to commit health care fraud and wire fraud. Cobos and Castano were the owners and
operators of Pharmacy Solution, a retail pharmacy in Miami-Dade County. The
indictment alleges that from on or about March 1, 2012 to September 17, 2014,
Cobos and Castano submitted and caused the submission of claims, via interstate
wires, which falsely and fraudulently represented that various health care
benefits, primarily prescription drugs, were medically necessary, prescribed by
a doctor and had been provided by Pharmacy Solution to Medicare
beneficiaries. As a result of these
false and fraudulent claims, Medicare prescription drug plan sponsors allegedly
made payments funded by the Medicare Part D Program to the corporate bank
accounts of Pharmacy Solution in the approximate amount of at least $2.1
million. This case was investigated by HHS-OIG and the FBI. Assistant U.S. Attorney Christopher J. Clark
of the Southern District of Florida is prosecuting this case.
Tania Rodriguez, 48, and Rafael Vidal, 61, both of Miami,
were charged by indictment with one count of conspiracy to commit healthcare
and wire fraud and seven counts of health care fraud. According to the indictment, the defendants
participated in a conspiracy to use their company, American United Pharmacy
Corp. of Miami, to offer and pay kickbacks for the referral of Medicare
beneficiaries to their pharmacy, and to submit false and fraudulent claims to
Medicare for prescription drugs that were not provided to Medicare
beneficiaries. Assistant U.S. Attorney
David Turken of the Southern District of Florida is prosecuting this case.
Ricardo Ignacio Perez, 54, and Ricardo Perez-Leon, 31, both
of Miami, the owners and operators of three Miami pharmacies, were charged by
indictment with one count of conspiracy to commit health care fraud and wire
fraud; one count of conspiracy to defraud the United States and pay and receive
health care kickbacks; and three counts of health care fraud. The indictment alleges that the defendants
participated in a scheme to pay kickbacks and bribes to patient recruiters and
to fraudulently bill Medicare drug plan sponsors for prescription
medications. The indictment alleges
that, during the course of the fraudulent scheme, the defendants received
approximately $5.3 million from Medicare drug plan sponsors for prescription
medications that were medically unnecessary, never provided and/or never
purchased by the defendants’ pharmacies.
This case was investigated by HHS-OIG and the FBI. The case is being prosecuted by Trial
Attorneys Sara Clingan and Tim Loper of the Fraud Section.
Steven Kahn, 61, of Boca Raton, and Pamela Edwin, 33, of
Delray Beach, the owner and office manager, respectively, of a Broward county
telemedicine company, were charged by indictment with one count of conspiracy
to commit health care fraud and wire fraud and three counts of wire fraud. Kahn
was also charged with five counts of money laundering. The indictment alleges that the defendants
paid kickbacks and bribes to physicians in exchange for signing doctors’
orders, and that the defendants then sold the doctors’ orders to Medicare
providers who used the orders to submit approximately $39 million in fraudulent
claims to Medicare. This case was
investigated by HHS-OIG and the FBI. The
case is being prosecuted by Trial Attorneys Sara Clingan and Catherine Wagner
of the Fraud Section.
Jordan Karlick, 33, of Boca Raton, Michael Moranz, 32, of
Lake Worth, and Jordan Chibnick, 36, of Plantation, the owners of Palm Beach
durable medical equipment (DME) companies, were charged by indictment with one
count of conspiracy to commit healthcare fraud and wire fraud, one count of
conspiracy to defraud the United States and pay kickbacks, four counts of
health care fraud, and three counts of payment of kickbacks. The indictment alleges that the defendants
paid kickbacks and bribes in exchange for signed doctors’ orders for DME, which
the defendants used to fraudulently bill Medicare for over $23 million. The indictment alleges that defendants sought
to impede Medicare beneficiary’s ability to return DME that they did not want
or need to defendants’ companies, so that defendants could continue to bill
Medicare for that DME. This case was
investigated by HHS-OIG and the FBI. The
case is being prosecuted by Trial Attorneys Sara Clingan and Catherine Wagner
of the Fraud Section.
Richard S. Mallia, D.P.M., 55, a podiatrist, was charged by
indictment with one count of conspiracy to defraud the United States and to
receive kickbacks, one count of conspiracy to commit health care fraud and wire
fraud, and three counts of health care fraud, for his role in a health care
fraud conspiracy that caused a loss of approximately $7.7 million to the
Medicare program. The indictment alleges
that Mallia accepted cash kickbacks in exchange for writing medically
unnecessary home health prescriptions and also participated in a scheme to
submit claims to Medicare for relatively expensive foot procedures that he
never performed. This case was
investigated by HHS-OIG, the FBI, and United States Secret Service. The case is
being prosecuted by Trial Attorney Alexander Pogozelski of the Fraud Section.
Peter Port, 64, of Boca Raton, Brian Dublynn, 62, of Fort
Lauderdale, and Jennifer Sanford, 57, of Hollywood, were charged for their
alleged participation in a scheme to defraud private health insurance
companies. Port, Dublynn and Sanford
were each charged with one count of conspiracy to commit health care fraud and
wire fraud and four counts of health care fraud. In addition, Port and Dublynn were each
charged with one count of conspiracy to commit money laundering and five counts
of money laundering. The defendants
caused Safe Haven Recovery Inc. (Safe Haven), a substance abuse treatment
facility in Miami, and several clinical laboratories to submit false and
fraudulent claims to health insurance plans for addiction treatment services
that were not provided as billed and laboratory tests that were not medically
necessary. This case was investigated by the FBI. This case is being handled by Trial Attorney
David A. Snider of the Fraud Section.
Maribel Sera, 51, of Hialeah, was charged by information
with conspiracy to defraud the U.S. and the solicitation and receipt of
kickbacks in connection with a federal health care program. According to the information, the defendant
participated in a conspiracy to solicit and receive kickback payments for the
referral of Medicare beneficiaries to TC Home Health Care of Hialeah. HHS-OIG
and the FBI investigated this case.
Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.
Francisco Abreu Tartabull, 53, of Miami, was charged by
indictment with conspiracy to commit health care fraud and wire fraud in
connection with his role in a $2.1 million private insurance fraud scheme. According to the indictment, Tartabull was
the owner and operator of South Dade Medical Center Inc. (South Dade), a Miami
medical clinic that purportedly provided Blue Cross Blue Shield insurance
beneficiaries with various medical treatments and services. As part of the fraudulent scheme, Tartabull
and his co-conspirators submitted more than $2.1 million in fraudulent claims
to Blue Cross Blue Shield. These claims
falsely represented that the benefits Tartabull’s clinic had billed insurance
for were medically necessary, prescribed by a doctor, and had been provided by
South Dade to these beneficiaries. As a
result of these false claims, Blue Cross Blue Shield paid Tartabull’s clinic
more than $920,000. Tartabull then used
this ill-gotten money for his own personal use and benefit, and to further the
fraud. The FBI investigated this
case. Assistant U.S. Attorney Anne P.
McNamara is prosecuting this case.
*********
The charges and allegations contained in the indictments are
merely accusations. The defendants are
presumed innocent until proven guilty beyond a reasonable doubt in a court of
law.
The Fraud Section leads the Medicare Fraud Strike Force
(MFSF), which is part of a joint initiative between the Department of Justice
and HHS to focus their efforts to prevent and deter fraud and enforce current
anti-fraud laws around the country.
Since its inception in March 2007, MFSF maintains 15 strike forces
operating in 24 districts and has charged nearly 4,000 defendants who have
collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare &
Medicaid Services, working in conjunction with HHS-OIG, are taking steps to
increase accountability and decrease the presence of fraudulent providers.
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