Miami-Area Clinic Owner Charged in $23 Million Health Care Fraud Scheme

May 15, 2010 - WASHINGTON—A Miami-area resident who owned and operated an HIV infusion clinic was arrested today and charged for her alleged participation in a $23 million HIV infusion Medicare fraud scheme, the Departments of Justice and Health and Human Services (HHS) announced.

An indictment unsealed today in U.S. District Court in Miami charges Flor Crisologo, 58, with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. Crisologo also is charged with one count of conspiracy to launder the proceeds of her crimes and four counts of money laundering. Crisologo made her initial appearance today in U.S. District Court in Miami before Magistrate Judge William C. Turnoff.

According to the indictment, Crisologo was the owner and operator of J & F Community Medical Center Inc. The indictment alleges that Crisologo submitted approximately $23 million in false and fraudulent claims to the Medicare program for HIV injection and infusion services purportedly provided through J & F. According to the indictment, Crisologo hired a physician at J & F and caused the physician to order unnecessary tests, sign false medical analyses and diagnosis forms, and authorize treatments to make it appear that medical services were being provided to patients who were Medicare beneficiaries. The services included medically unnecessary injection and infusion therapies. The indictment alleges that Crisologo and her co-conspirators paid Medicare beneficiaries kickbacks to induce the beneficiaries to claim they received legitimate services at the clinic when in fact the HIV infusion services were either not provided or were not medically necessary.

According to the indictment, Crisologo engaged in a scheme to launder the proceeds of the fraudulent Medicare claims by, among other things, transferring thousands of dollars in proceeds to two shell corporations that she owned and controlled, ABC Med Way Inc., and MSG Investment and Services Corp.

The maximum sentence for each count of conspiracy to defraud the United States and filing false claims is five years in prison. The maximum sentence for each count of conspiracy to commit health care fraud, conspiracy to commit money laundering, and money laundering is 10 years in prison. The indictment seeks forfeiture of assets held by the defendant.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

Today’s charges were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 560 individuals who collectively have falsely billed the Medicare program for more than $1.2 billion. In addition, the HHS 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.