Miami Woman Sentenced to 10-years for Role in $170M Healthcare Fraud Consiracy

540236_secret_garden.jpgOn April 2, the same day that seven co-defendants were indicted (click here) for their roles in an $11 million Medicare fraud scheme involving HIV infusion clinics, Rita Campos Ramirez who had pleaded guilty in August 2007 to a $170 million conspiracy to commit health care fraud was sentenced to 10 years in prison. According to the U.S. Department of Justice and local federal prosecutors, the scheme represents the largest known individual case of Medicare fraud in the history of the program.
In addition to the prison sentence, Campos will be placed on three years of supervised release following her release from prison; forfeit $207,000, her three homes and an automobile; and pay $105 million in restitution to the U.S. Department of Health and Human Services. According to court records, Campos’ attorney argued for leniency claiming that Campos cooperated with federal agents and placed herself in personal danger in helping further the investigation . However, U.S. District Court Judge Alan S. Gold was apparently unpersuaded. It is unknown whether Campos will receive any future reduction in sentence pursuant to Section 5K1.1 of the United States Sentencing Guidelines. Section 5K1.1 authorizes the government to file a motion asking the court to reduce a prisoner’s sentence based upon the nature and extent of their cooperation.
Campos pleaded guilty on August 28, 2007, to one count of conspiracy to commit health care fraud and one count of submitting false claims to Medicare. As part of her plea, Campos admitted (click here to read the statement of the offense) that between October 2002 and April 2006 she owned and operated R&I Medical Billing Inc., a medical billing company that specialized in submitting bills to the Medicare program on behalf of HIV infusion clinics. Campos admitted that she knowingly submitted approximately $170 million in fraudulent medical bills to Medicare on behalf of 75 HIV infusion clinics in Miami-Dade County that were part of the scheme. Infusion clinics serve HIV patients by providing prescribed medications intravenously. As I have reported previously, 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.
The Medicare program paid approximately $105 million of the $170 million in fraudulent bills submitted by Campos, with Campos personally receiving $5 million for her role in the fraud.
“Stealing public dollars for personal enrichment is a criminal act that will not be tolerated by the public or the Department of Justice. Today’s sentencing proves that defendants who violate the law and defraud Medicare, a program that provides essential health services to those who need it most, will be punished,” said Assistant Attorney General Alice S. Fisher.
“The rampant billing fraud perpetrated by this defendant squandered millions of dollars in scarce Medicare resources. The health care fraud epidemic in South Florida must stop, and the U.S. Attorney’s Office will continue to aggressively investigate and prosecute these cases.” said U.S. Attorney R. Alexander Acosta.
FBI Special Agent in Charge Jonathan I. Solomon said, “The sentence in this case dispels the myth that white collar crime defendants get off lightly. It reinforces the message that health care fraud – stealing from U.S. taxpayers – is a serious crime. The FBI will continue to combat health care fraud by helping put these criminals behind bars where they belong.”

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