National Health Care Fraud Enforcement Action Results in Charges of Over $308 Million in Intended Loss Against 52 Defendants in the Southern District of Florida | USAO-SDFL

Miami, Florida – Over 50 defendants were charged in the Southern District of Florida in the last six weeks, as part of a nationwide federal law enforcement action to combat health care fraud. 

The federal charges filed in South Florida cover a wide range of schemes, from novel crimes like theft of Covid-19 personal protection equipment and fraud connected to substance abuse treatment facilities (sober homes), to more familiar violations like health care fraud involving durable medical equipment suppliers, home health, pharmacies, payment of kickbacks, money laundering, and more.  It is alleged that $308 million in fraudulent claims was billed by the defendants charged in the Southern District of Florida during the six-week enforcement period.  Over $106 million of that billed amount was paid.    

Nationwide, 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States, were charged during the enforcement period for their alleged participation in various healthcare fraud schemes that resulted in approximately $1.4 billion in alleged losses. Nationally, the charges target approximately $1.1 billion in fraud committed using telemedicine (the use of telecommunications technology to provide health care services remotely), $29 million in COVID-19 health care fraud, $133 million connected to substance abuse treatment facilities, or “sober homes,” and $160 million connected to other health care fraud and illegal opioid distribution schemes across the country.

“The results of the coordinated law enforcement effort that we announce today exemplify my Office and its law enforcement partners’ enduring commitment to combatting all forms of health care fraud-related schemes.” said Juan Antonio Gonzalez, Acting U.S. Attorney for the Southern District of Florida. “We will not relent in holding accountable those in South Florida who exploit health care programs and patient trust for personal gain, particularly during the COVID-19 global pandemic.”

“This nationwide enforcement action demonstrates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “The charges announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a continued pandemic.”

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI, and the Drug Enforcement Administration (DEA), as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic.

The Southern District of Florida, in particular, worked with the Department’s Criminal Division and the following law enforcement organizations to investigate and prosecute the cases filed during the enforcement period: FBI Miami; U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region; Social Security Administration, Office of Inspector General (SSA-OIG), Atlanta Field Division; Homeland Security Investigations (HSI), Miami; United States Postal Inspection Service (USPIS), Miami Region; Florida’s Office of the Attorney General, Medicaid Fraud Control Unit (MFCU); Florida State Attorney’s Office; City of Miami Beach Police Department; Palm Beach County Sober Homes Task Force; Amtrack Office of the Inspector General; and the Department of Insurance Fraud.

“South Florida is ground zero for health care fraud.  As such, the FBI and its partners devote vast resources to investigate, catch and prosecute those committing this fraud,” said George L. Piro, Special Agent in Charge, FBI Miami.  The victims are U.S. taxpayers, you and me.  Our message to those who commit health care fraud and steal from U.S. taxpayers is clear: you will be caught, and you will be punished.”

“Healthcare fraud is hardly a victimless crime. The well-being and trust of patients and taxpayers are at risk when corrupt providers engage in schemes that drain taxpayer-funded health care programs and undermine impartial medical judgement,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG Miami. “These cases demonstrate our resolve to investigate bad actors and protect the patients served by vital federal health and human services programs.”

Those who misuse the Social Security numbers of other individuals for personal gain are warned — we will hold you accountable.” said Rodregas W. Owens, Special Agent-in-Charge, SSA-OIG, Atlanta Field Division. “We will continue to work aggressively to identify such fraud in an effort to protect taxpayers against fraud, waste, and abuse.”

“We as a law enforcement community will not allow individuals to defraud government health-care programs for their own personal gain,” said Anthony Salisbury, Special Agent in Charge, HSI Miami. “HSI and its partners will continue to pursue individuals and companies who are taking advantage of innocent patients seeking medical care.”

“My Medicaid Fraud Control Unit works tirelessly to stop the exploitation of the taxpayer-funded Medicaid program and protect the vulnerable Floridians who rely on its services. I’m proud of our partnership with federal authorities to hold these criminals abusing the system accountable,” said Florida Attorney General Ashley Moody.

COVID-19 Fraud Cases

Across the nation, nine defendants are charged with engaging in various health care fraud schemes designed to exploit the COVID-19 pandemic, which resulted in the submission of over $29 million in false billings.

In the Southern District of Florida, for example, a defendant is charged with stealing personal protective equipment from a hospital and reselling it at inflated prices:   

In U.S. v. Rickey Delancey, Jr., Case No. 21-20471-Cr-Moore, a 30-year-old Miami resident is charged by indictment with conspiracy to steal medical products, theft of medical products, and transportation of stolen goods. According to the indictment, Delancey worked in the supplies department of Mount Sinai Hospital. From about April to November 2020, Delancey stole N95 masks and other medical supplies from his workplace and sold them to various purchasers.  Among other items, he sold $55,000 worth of stolen masks to a purchaser in California, says the indictment. As a result of the thefts, during the height of the COVID-19 pandemic, Mount Sinai did not have the supplies needed for nurses, doctors, staff, and patients, and at one point was down to only a three-day supply of N95 masks.

FBI Miami and USPIS Miami investigated this case, along with City of Miami Beach Police Department.  Southern District of Florida Assistant U.S. Attorney Lindsey Lazopoulos Friedman is prosecuting it.

The law enforcement action today also includes criminal charges against five defendants across the country who allegedly engaged in the misuse of Provider Relief Fund monies. The Provider Relief Fund is part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a federal law enacted March 2020 designed to provide needed medical care to Americans suffering from COVID-19.

The COVID-19 cases announced today build upon the success of the COVID-19 Health Care Fraud Takedown on May 26, a coordinated law enforcement action against 14 defendants in seven judicial districts for over $128 million in false billings. The law enforcement action and the cases announced today were brought in coordination with the Health Care Fraud Unit’s COVID-19 Interagency Working Group, which is chaired by the National Rapid Response Strike Force and organizes efforts to address illegal activity involving health care programs during the pandemic.

Sober Homes Cases

Today’s announcement of sober homes cases charged across the nation coincides with the one-year anniversary of the first national sober homes initiative in 2020, which included charges against more than a dozen criminal defendants in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction. The over $133 million in false and fraudulent claims that are additionally alleged in cases announced today reflect the continued effort by the National Rapid Response Strike Force and the Health Care Fraud Unit’s Los Angeles Strike Force, with the participation of the U.S. Attorney’s Offices for the Central District of California and the Southern District of Florida, to prosecute those who participated in illegal kickback and bribery schemes involving the referral of patients to substance abuse treatment facilities; those patients could be subjected to medically unnecessary drug testing – often billing thousands of dollars for a single test – and therapy sessions that frequently were not provided, and which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers.

In the Southern District of Florida, two defendants are charged with sober homes fraud:

In United States v. Mimi Bieda and Levi Bieda a/k/a Larry, Case No. 21-80112-CR-Rosenberg, Mimi Bieda, 62, and Levi Bieda, 36, of West Palm Beach, Florida, are charged by information with conspiracy to commit $128 million of health care fraud.  According to the information, the Biedas owned and operated Academy Health Solutions, LLC (“Academy”), a substance abuse treatment center in Palm Beach County, Florida, as well as a sober home and detox facilities.  They also had ownership interest in several drug testing laboratories.  It is alleged that the Biedas hired a medical director for Academy, Dr. Michael Ligotti, who signed standing orders for medically unnecessary and expensive drug testing in exchange for patient referrals. Dr. Ligotti then billed the patients’ insurance plans for duplicative, excessive, non-rendered, and/or medically unnecessary treatment and testing.  The Biedas used the standing orders signed by Dr. Ligotti, and by a subsequent medical director at Academy, to authorize medically unnecessary drug testing at laboratories in which they had an ownership interest, allowing them to receive percentages of all claim reimbursements for those tests, says the information. It is alleged that the Biedas also paid kickbacks and bribes, in the form of free or reduced rent, access to controlled substances provided by Academy’s medical directors, and other benefits, to individuals who agreed to live at their sober home, attend treatment at Academy, and submit to drug testing, so that the Biedas could bill these services to the residents’ insurance plans. 

FBI Miami investigated this case, along with Palm Beach County Sober Homes Task Force, Florida State Attorney’s Office, Amtrack Office of the Inspector General, and Department of Insurance Fraud.  Southern District of Florida Assistant United States Attorneys Alexandra Chase and Danielle Croke, as well as National Rapid Response Strike Force Senior Litigation Counsel James V. Hayes and Trial Attorney Ligia Markman are prosecuting it.  

Cases Involving Traditional Healthcare Fraud Schemes and the Illegal Prescription and/or Distribution of Opioids

The cases announced today that fall into more traditional categories of health care fraud include charges filed across the nation against over 60 defendants who allegedly participated in schemes to submit more than $145 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. Cases filed across the nation involving the illegal prescription and/or distribution of opioids involve 19 defendants, including several charges against medical professionals and others who prescribed over 12 million doses of opioids and other prescription narcotics, while submitting over $14 million in false billings.

In the Southern District of Florida, defendants are charged in cases involving a wide range of traditional health care fraud schemes.  Some of the cases charged in the Southern District of Florida during the six-week enforcement period include the following:

In United States v. Edward Pizzi, Case No. 21-20467-CR-Altman, a 40-year-old from Miami, Florida is charged by information with conspiracy to pay health care kickbacks. According to the information, Pizzi owned and operated Miami-based Rios Medical Center and Union Medical Clinic. Pizzi directed his employees to pay kickbacks to recruit Medicare beneficiaries and Medicaid recipients to the clinics.  The clinics used the identification numbers of these beneficiaries and recipients to submit claims to Medicare Part C and Medicaid for, among other things, purported mental health therapy services.  Most of the recruited beneficiaries neither needed nor qualified for such services.  

FBI Miami, HHS-OIG Miami, and MFCU investigated this case. Southern District of Florida Assistant U.S. Attorney Michael Homer is prosecuting it. 

In United States v. Mayara Gonzalez Chaviano, Case No. 21-20468-CR-King, a 28-year-old Miami, Florida resident is charged by information with conspiracy to pay health care kickbacks.  According to the information, Chaviano was the office manager of Rios Medical Center and Union Medical Clinic, in Miami, Florida.  Chaviano managed the clinics’ scheme to pay kickbacks to recruit Medicare beneficiaries and Medicaid recipients to the clinics. The clinics used the identification numbers of these beneficiaries and recipients to submit claims to Medicare Part C and Medicaid for, among other things, purported mental health therapy services.  Most of the recruited beneficiaries neither needed nor qualified for such services. 

FBI Miami, HHS-OIG Miami, and MFCU investigated this case. Southern District of Florida Assistant U.S. Attorney Michael Homer is prosecuting it.

In United States v. Liliana Liseth Duarte, Case No. 21-20469-CR-Bloom, a 47-year-old resident of Miami, Florida, is charged by information with conspiracy to pay health care kickbacks.  According to the information, Duarte was an employee of Rios Medical Center and Union Medical Clinic, in Miami, Florida. Duarte paid kickbacks to individuals to recruit Medicare beneficiaries and Medicaid recipients to the clinics. The clinics used the identification numbers of these beneficiaries and recipients to submit claims to Medicare Part C and Medicaid for, among other things, purported mental health therapy services.  Most of the recruited beneficiaries neither needed nor qualified for such services. 

FBI Miami, HHS-OIG Miami, MFCU investigated this case. Southern District of Florida Assistant U.S. Attorney Michael Homer is prosecuting it.

In United States v. Jason Kashou, Case No. 21-60245-CR-Dimitrouleas, the 35-year-old owner of 1st Choice is charged by information with conspiracy to solicit and receive illegal kickbacks from pharmacies. Kashou bought Medicare and Medicaid beneficiary information from a call center in India. Kashou then agreed to provide the beneficiary information to pharmacies so that the pharmacies could fill prescriptions for expensive diabetic supplies and topical pain creams. In exchange, the pharmacies agreed to pay Kashou a percentage of the profits from the amount Medicare and Medicaid paid on a per patient basis. 

On September 14, Kashou pled guilty to the charge.  His sentencing hearing is set for November 23, at 1:15 p.m., before U.S. District Judge William P. Dimitrouleas.

HSI Miami, HHS-OIG Miami and MFCU investigated this case. Southern District of Florida Assistant U.S. Attorneys Stephanie Hauser and Michael Gilfarb are prosecuting it.

In United States v. Greisy Rosario Varona Docasal, Case No. 21-20439-CR-Cooke, a 52-year-old Miami, Florida resident is charged by indictment with conspiracy to receive health care kickbacks, and substantive counts of receiving kickbacks in connection with a federal health care program. According t0 the indictment, Varona Docasal, as office manager of a doctor’s office, was involved in a scheme to illegally recruit Medicare beneficiaries and refer them to home health agencies in exchange for receiving illegal kickbacks from the owners and operators of the home health agencies who in turn billed Medicare for home health services for the recruited Medicare beneficiaries.

HHS-OIG Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Aimee C. Jimenez is prosecuting it.

In United States v. Mayra De La Paz, Case No. 21-20474-CR-Bloom, a 69-year-old resident of Hialeah, Florida is charged by information with conspiracy to solicit and receive kickbacks in connection with a federal health care program.  According to the information, De La Paz participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to a home health agency.

HHS-OIG Miami and FBI Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Timothy J. Abraham is prosecuting it.

In U.S. v. Michael Marcelus Mogollon, Case No. 21-20432-CR-Moore, a 33-year-old from Miami, Florida is charged by information with conspiracy to commit health care and wire fraud. According to the information, Mogollon paid kickbacks to beneficiaries with Blue Cross Blue Shield health insurance in exchange for the patients allowing Miami clinics Quality Professional, Zion Medical, and Renewal to bill the insurance plans for medical benefits, items, and services, that were not medically necessary, not eligible for reimbursement, and not received by the beneficiaries. As a result of Mogollon’s participation in the conspiracy, the clinics billed Blue Cross Blue Shield approximately $678,800, and Blue Cross Blue Shield paid approximately $220,000 based on the false claims, says the information.

FBI Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Lindsey Lazopoulos Friedman is prosecuting it.    

In U.S. v. Jorge Luis Taboada, Case No. 21-20443-CR-Williams, a 52-year-old resident of Miami, Florida is charged by information with conspiracy to commit health care and wire fraud. According to the information, Taboada paid kickbacks to beneficiaries with Blue Cross Blue Shield and Aetna health insurance in exchange for the patients allowing United Medical of South Florida, d/b/a Sleep Study of South Florida, Inc. to bill the insurance plans for medical benefits, items, and services, that were not medically necessary, not eligible for reimbursement, and not received by the beneficiaries. As a result of Taboada’s participation in the conspiracy, the clinics billed Blue Cross Blue Shield and Aetna between $1,500,000 and $3,500,000, says the information. 

FBI Miami investigated this case.  Southern District of Florida Assistant U.S. Attorney Lindsey Lazopoulos Friedman is prosecuting it.    

In United States of America vs. Patricia M. Cleary, a/k/a Patricia M. Cleary Syling, a/k/a Patricia M. Syling, a/k/a Patricia A. Cleary, Case No. 21-60262-CR-Singhal, a 51-year-old from Odessa, Florida is charged by indictment with one count of falsely representing a social security number and one count of aggravated identity theft.

According to the indictment, Cleary knowingly gave a false social security number to a Medicaid Managed Care Organization while applying for a job with the company. The social security number did not belong to Cleary. Instead, it belonged to a victim living in a different state. Cleary did this to hide her real identity from the company, says the indictment.

HHS-OIG Miami, State of Florida Medicaid Fraud Control Unit, SSA-OIG Miami, and FBI Miami investigated this case. Southern District of Florida Special Assistant U.S. Attorney Marc Canzio is prosecuting it.

In United States v. Julio Cesar Betancourt, Case No. 21-20425-CR-Moore, a 31-year-old resident of Hialeah Gardens, Florida is charged by information with conspiracy to commit money laundering.  According to the information, Betancourt, as owner of owner of JD Solution USA, Inc., conspired to launder $363,139 in health care fraud proceeds between July 2019 and October 2019.  These proceeds were related to a durable medical equipment company located in Miami that was committing health care fraud, says the information.

HHS-OIG Miami and FBI Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Timothy J. Abraham is prosecuting it.

In United States v. Jorge Luis Lopez Pena, Case No. 21-CR-20466-Gayles, a 36-year-old from Miami, Florida is charged by information with conspiracy to commit money laundering.  According to the information, Lopez Pena, as owner of Lopez Distributors, Inc., conspired to launder $185,671 in health care fraud proceeds between August 2019 and December 2019. These health care fraud proceeds were related to a durable medical equipment company located in Miami that was committing health care fraud, says the information.

HHS-OIG Miami and FBI Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Timothy J. Abraham is prosecuting it.

In U.S. v. Angel Pimentel, Case No. 21-20420-CR-King, a 72-year-old from Miami, Florida, is charged by indictment with conspiracy to commit health care fraud and substantive counts of health care fraud.  According to the indictment, Pimentel owned Maggie Pharmacy Discount, Inc. From about March 2015 to August 2019, Pimentel submitted $988,983 in claims to Medicare, which falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Maggie Pharmacy Discount, Inc. to Medicare beneficiaries.  As a result of the false claims, Medicare prescription drug plan sponsors, through their pharmacy benefit managers, made payments funded by the Medicare Part D Program to the corporate bank accounts of Maggie Pharmacy Discount, Inc. of at least $988,983, says the indictment.

HHS-OIG Miami and FBI Miami investigated this case. Southern District of Florida Assistant U.S. Attorney Christopher J. Clark is prosecuting it.

Prior to the charges announced as part of today’s nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,600 defendants who have collectively billed the Medicare program for approximately $23 billion. In addition to the criminal actions announced today, CMS, working in conjunction with HHS-OIG, announced 28 administrative actions to decrease the presence of fraudulent providers.

Telemedicine Fraud Cases

More than 43 criminal defendants in 11 judicial districts nationwide are charged in cases involving telemedicine: the use of telecommunications technology to provide health care services remotely. It is alleged that these telemedicine defendants filed over $1.1 billion in fraudulent claims. 

The continued focus on prosecuting health care fraud schemes involving telemedicine reflects the success of the nationwide coordinating role of the Fraud Section’s National Rapid Response Strike Force, the creation of which was announced at the 2020 National Health Care Fraud and Opioid Takedown. The National Rapid Response Strike Force helped coordinate the prosecution of the telemedicine initiative, Sober Homes initiative, and COVID-19 cases that were announced today. The focus on telemedicine fraud also builds on the telemedicine component of last year’s national takedown and the impact of the 2019 “Operation Brace Yourself” Telemedicine and Durable Medical Equipment Takedown, which resulted in an estimated cost avoidance of more than $1.9 billion in the amount paid by Medicare for orthotic braces in the 20 months following that takedown.

Health Care Fraud Prosecutions in the Southern District of Florida for

Fiscal Year 2020-2021

The Southern District of Florida is a national leader in health care fraud prosecutions.  So far, during the 2020-2021 Fiscal Year (from October 1, 2020 through today), a total of 196 defendants have been charged in the Southern District of Florida with health care fraud-related offenses.  It is alleged that approximately $2.2 billion was billed by these defendants and that approximately $488 million was paid.   

A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

###

Source link

Author: Editor
The website is owned by STL.News, LLC. However, the website is hosted, designed, and maintained by WebTech Group, a web host, and design agency based in St. Louis, Missouri. USDOJ.Today focuses on aggregating content from the US Attorney's Offices around the country. STL.News uses this content to publish national news at https://STL.News