Feds Charge Seven in $11 Million Medicare Fraud Scheme

253396_iv_drip_-_intravenous_treatmen.jpgSeven Miami-area residents were indicted on April 2, 2008, in connection with an $11 million Medicare fraud scheme involving HIV infusion clinics. The defendants were all charged with: conspiracy to defraud the United States, to cause the submission of false claims, to pay health care kickbacks, and conspiracy to commit health care fraud.
According to a report filed early last fall, by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.
According to the indictment, Mariela Rodriguez and Perera incorporated Saint Jude Rehab Center, Inc. (Saint Jude) in April 2003 as a medical clinic that purported to specialize in treating HIV patients. Delgado, a receptionist at Saint Jude, agreed to be incorrectly listed on filed corporate records as president and registered agent of Saint Jude. Mariela Rodriguez and Perera hired Dr. Ana Alvarez to work at Saint Jude despite having no prior expertise in the clinic’s proclaimed specialty of treating HIV patients. Dr. Alvarez ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments without regard to medical necessity, to make it appear that legitimate medical services were being provided to HIV patients receiving Medicare benefits.
The indictment further charges that during the conspiracy, Mariela Rodriguez, Perera, and Delgado withdrew cash from Saint Jude’s bank account for Angel Rodriguez, Mateos and Gonzalez, assistants at Saint Jude, to pay cash kickbacks of approximately $100 to $150 per visit to HIV patients. In return for the kickbacks, patients signed logs stating that they had received the treatments that were billed to Medicare, when in fact the patients had not received the claimed treatments.
From June 2003 through November 2003, Saint Jude billed approximately $11 million to the Medicare program under the Medicare provider numbers of Dr. Alvarez and Dr. Orestes Alvarez-Jacinto, receiving more than $8 million in payments for HIV infusion services that were not actually provided and services that were not medically necessary.
Dr. Orestes-Alvarez Jacinto, a former doctor at Saint Jude, pleaded guilty in June 2007 to conspiracy to commit health care fraud and was sentenced in October 2007 to 18 months in prison.
If convicted on all charges, Mariela Rodriguez, Perera and Delgado each face maximum prison sentences of 35 years. Alvarez faces a maximum prison sentence of 30 years while Angel Rodriguez, Mateos and Gonzalez each face maximum prison terms of 15 years.