PHYSICIAN’S ASSISTANT PLEADS GUILTY TO ROLE IN $119 MILLION FRAUDULENT HIV INFUSION SCHEME

MIAMI, FL (September 18, 2008) – Thomas McKenzie, 53, a Miami physician’s assistant pleaded guilty today to defrauding the Medicare program in connection with a $119 million HIV infusion fraud scheme.
logbook.jpgMcKenzie, pleaded guilty in Miami to one count of conspiracy to commit healthcare fraud and one count of submitting false claims to the United States. McKenzie admitted that beginning in approximately December 2001 and continuing through approximately April 2004, he trained physicians at 11 Miami medical clinics how to make medical records appear to support medically unnecessary HIV infusion services allegedly administered to patients. McKenzie also admitted to overseeing the documentation of fraudulent services at these clinics to make it appear that legitimate services were being provided at those facilities.
infusion.1.jpgAccording to information contained in plea documents, McKenzie entered into an agreement with brothers Carlos, Luis and Jose Benitez to assist them in operating a series of fraudulent HIV infusion clinics throughout south Florida. The Benitez brothers allegedly referred HIV-positive Medicare beneficiaries to these clinics and directed clinic staff to pay cash kickbacks to the patients. McKenzie admitted that his role at the Benitez-owned clinics was to train and oversee the physicians working there, ensuring that the medical records appeared to support the expensive HIV infusion treatments being billed to Medicare by the clinics.
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 these types of criminal operations. To read those articles and to learn more about the Benitez brothers click here.
McKenzie admitted to knowing that the infusion treatments being billed at the clinics were medically unnecessary and/or never provided. In his plea, McKenzie admitted that the HIV infusion clinics where he worked submitted $119 million in fraudulent claims to Medicare for medically unnecessary HIV infusion therapy.
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.
McKenzie’s co-conspirators, Carlos, Luis and Jose Benitez, were indicted with McKenzie on June 11, 2008, for their role in the HIV infusion and money laundering scheme. The indictment alleges that Carlos, Luis and Jose Benitez were the masterminds of a massive HIV infusion fraud operation throughout South Florida, involving at least 11 clinics, and that they laundered the proceeds of their crimes. All three Benitez brothers remain fugitives.
In addition to McKenzie, to date, 10 additional co-conspirators have pleaded guilty for their roles in the HIV infusion fraud and money laundering scheme. They are:
1. On June 12, 2007, Dr. Orestes Alvarez-Jacinto pleaded guilty to one count of conspiracy to commit health care fraud, in connection with his role as medical director and doctor at Saint Jude, a Miami HIV infusion clinic owned by the Benitez brothers that submitted approximately $11 million in fraudulent claims to the Medicare program. On Oct. 2, 2007, Alvarez-Jacinto was sentenced to 18 months in prison and three years supervised release. Alvarez-Jacinto was also ordered to forfeit $100,000, representing his proceeds from the fraud, and ordered to pay approximately $5.2 million in restitution. To read about this case in a previous blog post, click here.
2. On Aug. 28, 2007, medical biller Rita Campos Ramirez pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the United States, in connection with her role as medical biller for the Benitez brothers-owned clinics and other HIV infusion clinics. In pleading guilty, Campos Ramirez admitted to submitting approximately $170 million in fraudulent claims to the Medicare program for HIV infusion and related services. On March 26, 2008, Campos Ramirez was sentenced to 120 months in prison and three years supervised release, and ordered to forfeit her three homes, a Mercedes-Benz and $206,000. Campos Ramirez was also ordered to pay approximately $105 million in restitution.
3. On April 23, 2008, Aisa Perera pleaded guilty to one count of conspiracy to commit health care fraud, in connection with her role as the co-administrator of Saint Jude. On July 10, 2008, Perera was sentenced to 30 months in prison and three years supervised release. Perera was also ordered to pay approximately $8.2 million in restitution. To read about this case in an earlier blog post, click here.
4. On Aug. 26, 2008, Mariela Rodriguez pleaded guilty to one count of conspiracy to commit health care fraud and one count of making a false declaration before a grand jury, in connection with her role as co-administrator of Saint Jude. Rodriguez’s sentencing is scheduled for Nov. 4, 2008. To read about this case in an earlier blog post, click here.
5. On Aug. 26, 2008, Dr. Ronald Harris pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of false claims, in connection with his role as medical director and physician at PMC and PHMC, two of the Miami HIV infusion clinics owned by the Benitez brothers that submitted approximately $37 million in fraudulent claims to the Medicare program. Harris’s sentencing is scheduled for Nov. 4, 2008.
6. On Aug. 28, 2008, Nayda Freire pleaded guilty to one count of conspiracy to commit health care fraud, in connection with her role as president and registered agent of Global, a Miami HIV infusion clinic owned by the Benitez brothers that submitted approximately $11 million in fraudulent claims to the Medicare program. Freire’s sentencing is set for Nov. 5, 2008.
7. On Aug. 29, 2008, Juan Carlos Castaneda pleaded guilty to one count of conspiracy to commit money laundering, in connection with his role in laundering approximately $4 million for the administrators of G&S and another medical clinic. Castaneda’s sentencing is set for Nov. 7, 2008.
8. On Sept. 9, 2008, Dilcia Marinez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, in connection with her role as president and director of G&S, a Miami HIV infusion clinic owned by the Benitez brothers that submitted approximately $14 million in fraudulent claims to the Medicare program. Marinez is scheduled to be sentenced on Nov. 18, 2008. To read bout this case in a previous blog post, click here.
9. On Sept. 11, 2008, Dr. Carlos Contreras pleaded guilty to one count of conspiracy to commit health care fraud, in connection with his role as an owner and doctor of CNC, a Miami HIV infusion clinic co-owned by the Benitez brothers that submitted approximately $7 million in fraudulent claims to the Medicare program.
Dr. Ramon Pichardo also pleaded guilty to one count of conspiracy to commit health care fraud, in connection with his role as doctor at CNC. Contreras and Pichardo are scheduled to be sentenced on Nov. 20, 2008. Collectively, these defendants fraudulently billed the Medicare program for more than $492 million. To read more about Drs. Contreras and Pichardo in an earlier blog post, click here.
A copy of the original press release may be found at http://www.usdoj.gov/usao/fls.