Miami-area Clinic Owner Sentenced to 5 Years Prison for Home Health Agency Medicare Fraud Scheme; Four Nurses Sentenced

handcuffs-and-calculator-on-headlines-about-white-collar-crime.jpgMIAMI, FL – Yudel Cayro, the owner and operator of Courtesy Medical Group, was sentenced to 5 years behind bars for his role in a wide-ranging Medicare fraud scheme.
U.S. District Judge Adalberto Jordan also ordered Cayro to serve two years of supervised release following his prison term and ordered him to pay $9.8 million in restitution with his co-defendants and co-conspirators in a related case to the Centers for Medicare and Medicaid Services (CMS.)
doctor-writing-prescription.jpgAccording to the Factual Proffer signed by Caryo at the time that he pleaded guilty, he admitted that Courtesy Medical Group operated in part to provide unnecessary prescriptions, plans of care (POC’s) and medical certifications, among other things, to Miami-area home health agencies in return for kickbacks and bribes. Courtesy supplied the fraudulent medical documents so that the home health agencies could bill the CMS for expensive home health services and therapy purportedly for insulin dependent diabetic Medicare beneficiaries. However, the services were not medically necessary and in some cases the beneficiaries did not receive the services.
money-pile.jpg In the Factual Proffer, Caryo also admits that approximately 344 prescriptions for these unnecessary services were issued through Courtesy and signed by Cayro’s co-defendant, Dr. Fred Dweck, who is scheduled to be sentenced early next year. As a result, Medicare was fraudulently billed approximately $16.6 million for home health services. Medicare paid almost $10 million of the fraudulent claims. Another owner and operator of Courtesy, co-defendant Arturo Fonseca, was sentenced in November 2010, by Judge Jordan to 5 years in prison and two years of supervised release. Fonseca’s Factual Proffer is available for viewing by clicking here.
prison.jpgThree of Cayro’s co-defendants, Miami-area nurses Armando Sanchez, Marlenys Fernandez and Silvio Ruiz were sentenced last week to prison for their roles in the scheme. Sanchez and Fernandez were each sentenced to two and a half years in prison. Ruiz was sentenced to four months in prison. Judge Jordan also ordered Fernandez to pay $331,622, Sanchez to pay $602,585, and Ruiz to pay $79,230 in restitution to CMS, jointly and severally with their co-defendants and co-conspirators in a related case.
Two weeks ago, another co-defendant, registered nurse Sheillah Rotta, was sentenced by Judge Jordan to two months in prison, followed by two years of supervised release, for her participation in the scheme. Rotta was also ordered to pay $74,164 in restitution to CMS, jointly and severally with her co-defendants and co-conspirators in a related case.
file-stack.jpgAccording to the Factual Proffers submitted at the time they pleaded guilty, the nurses were engaged in the fraudulent scheme at ABC Home Health and Florida Home Health Care Providers Inc., two Miami home health agencies that were engaged in billing the Medicare program for unnecessary home health services for Medicare beneficiaries. Specifically, the nurses admitted to falsifying patient files to make it appear that these Medicare beneficiaries qualified for two to three times daily skilled nursing visits to purportedly administer diabetic insulin injections. However, these Medicare beneficiaries did not need nor qualify for these services.
courtroom.jpgAccording to court documents, Sanchez admitted that as a result of his actions, more than $900,000 was falsely billed to the Medicare program (click to read his Plea Agreement and here to read his Factual Proffer; Fernandez admitted to causing approximately $500,000 in fraudulent billings to Medicare (click here to read her Plea Agreement and here to read the Factual Proffer); Rotta admitted to causing more than $100,000 in fraudulent billing (click here to read her Factual Proffer); and Ruiz admitted to causing approximately $115,000 in fraudulent billing.
The cases were brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Florida and the Criminal Division’s Fraud Section. Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for more than $2 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.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov/