Miami Physicians Plead Guilty and Admit Ordering $6.8M Worth of Unnecessary HIV Infusion Treatments

infusion.jpgMIAMI, FL (September 11, 2008) – Miami physicians, Carlos Contreras, M.D., and Ramon Pichardo, M.D., each pleaded guilty today to defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme. To read the indictment in its entirety, click here.
%24benjamins.jpgContreras, 60, pleaded guilty to conspiracy to commit healthcare fraud and admitted that he owned a Miami clinic named CNC Medical Inc. (CNC), which purported to specialize in the treatment of HIV positive patients. From November 2002 through April 2004, Contreras admitted that he conspired with others to submit approximately $6.8 million in fraudulent Medicare bills; that he knowingly signed documents containing false information about treatments purportedly given to HIV positive patients. Contreras admitted that he approved medically unnecessary treatments at CNC and that CNC received approximately $4.2 million from the Medicare program as a result of his and his co-conspirators’ criminal conduct.
Furthermore, Contreras admitted that he entered into an agreement in approximately November 2002 with Carlos Benitez, Luis Benitez, Thomas McKenzie, Pichardo and others to operate CNC as a fraudulent HIV infusion clinic.
According to a report by the Inspector General for the U.S. Department of Health and Human Services made public a year ago, for which attorney, Benson Weintraub, a frequent contributor to this blog was interviewed by the Washington Times (click here to read that blog post), 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.
Miami Herald investigative reporter Jay Weaver wrote a series of articles last month disclosing the intricacies often associated with Medicare fraud / money laundering conspiracies. Those articles are quite revealing and detail the underworld character of these types of criminal operations. To read those articles click here.
Contreras admitted that the Benitez brothers would refer HIV positive Medicare beneficiaries to the clinic, provide staff members to work at the clinic and transport patients to CNC, in exchange for a substantial share of CNC’s profits. Contreras was aware that the patients referred to CNC by the Benitezes were paid cash kickbacks in exchange for visiting the clinic and allowing their names to be used to bill the Medicare program. Contreras admitted that he agreed to approve expensive and medically unnecessary HIV infusion claims at the clinic, and to falsify medical records. Medicare has since discontinued reimbursement for these types of outdated types of infusion therapies.
Pichardo, 58, also pleaded guilty to one count of conspiracy to commit health care fraud. Pichardo admitted in his plea that he worked as a physician at CNC, and conspired with Carlos and Luis Benitez, McKenzie, Contreras and others to assist in operating CNC as a fraudulent HIV infusion clinic. Pichardo further admitted that he and Contreras ordered numerous unnecessary and expensive HIV infusion treatments for the purpose of defrauding Medicare rather than providing legitimate health care services.
Drs. Contreras and Pichardo will be sentenced 11/20/2008 09:30 AM in Miami before Chief Judge Federico A. Moreno. Both physicians face likely permanent revocation of their license to practice medicine.
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