Thirty-Two South Florida Residents Charged as Part of Nationwide Takedown by Medicare Fraud Strike Force Operations

111 Individuals Charged for Fraud Schemes Involving More Than $225 Million in False Billings; Doctors, Nurses, Company Owners and Executives Among the Defendants Charged

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced that thirty-two (32) South Florida residents were charged for their alleged roles in various schemes to defraud Medicare. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in nine districts that led to charges against 111 defendants for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing. Medicare Fraud Strike Force operations throughout the country were modeled after the Miami strike force, which was the first in the nation.

U.S. Attorney Wifredo Ferrer stated, “This operation confirms that there is no safe harbor for Medicare fraudsters and that we will aggressively pursue all types of schemes and all types of offenders. This week, we arrested dozens of South Florida residents, including doctors, nurses, therapists, patient recruiters, money launderers, and others who chose to steal precious health care dollars. We also prosecuted a variety of fraud schemes involving community mental health fraud, home health care fraud, infusion fraud, Part D prescription fraud, durable medical equipment fraud, and even schemes against the Federal Employee Health Benefit Program. This week’s operation demonstrates that we will fight the battle against health care fraud on all fronts and will prosecute each link in the fraud chain and each emergent fraud scheme.”

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential health care programs, Medicare and Medicaid,” said Attorney General Holder. “As today's arrests prove, we are waging an aggressive fight against health care fraud.”

“People who defraud Medicare and private insurance companies indirectly increase the cost of health care for everyone,” said FBI Special Agent in Charge John V. Gillies. “The FBI is committed to rooting out health care fraud and reclaiming money improperly paid by government-sponsored programs and private insurers. The strike force gives us the necessary prosecutorial support to attack this multi-billion-dollar crime problem.”

“Today’s indictments and arrests mark a continuation of operations to flush out health care fraud in South Florida,” said Christopher Dennis, the Miami Region’s Special Agent in Charge for the Office of Inspector General of the Department of Health & Human Services. “The actions we have taken today are part of a coordinated sweep in our battle against the scourge of Medicare and Medicaid fraud.”

The Indictments announced today as part of the nationwide Medicare Fraud Strike Force operations include:

United States v. Jose Nunez, M.D., et al.

Twenty-one Miami-area residents, including two doctors, six nurses, 11 patient recruiters, and two employees, were arrested and charged for their alleged participation in a $25 million home health care Medicare fraud scheme. Jose Nunez, M.D., Francisco Gonzalez, M.D., Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., a/k/a “Maritza Casas,” Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Luisa Morciego, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, Lisandra Alonso and Licet Diaz, were indicted on February 10, 2011 on various health care fraud charges, including conspiracy to commit health care fraud, making false statements, and soliciting kickbacks.

The indictment alleges that ABC Home Health, Inc. (ABC) and Florida Home Health Care Providers, Inc. (Florida Home Health) referred Medicare beneficiaries to Drs. Nunez and Gonzalez for medically unnecessary home health care. The doctors would sign prescriptions for therapy and home health services, and then received illegal kickback payments from the owners and operators of ABC and Florida Home Health. In addition, the doctors would receive Medicare payments for home health care services, including office visits and diagnostics tests. The indictment further alleges that Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, and Lisandra Alonso would receive kickbacks and bribes for recruiting Medicare beneficiaries to be referred for home health services through doctors working with ABC and Florida Home Health. Finally, the indictment alleges that Licet Diaz distributed kickback payments to patient recruiters on behalf of the owners of ABC and Florida Home Health. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

United States v. Emilio Bezanilla

Emilio Bezanilla was charged with seven counts of laundering the proceeds of health care fraud and two counts of structuring transactions to avoid currency transaction reporting requirements. The indictment alleges that Bezanilla laundered thousands of dollars for five companies that engaged in health care fraud: Mercy Medical Supply, Inc., JHH Group, Inc., Yani’s Pharmacy, Inc., and La Numero 1 Farmacia Discount Corp. The indictment also alleges that Bezanilla structured the withdrawal of cash in denominations under $10,000 to avoid the requirement that banks report large cash withdrawals. This case being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Victor Ramon Castillo

Victor Ramon Castillo was charged with five counts of health care fraud, in connection with Vida Group Services, Inc., in Miami, Florida. The indictment alleges that Castillo incorporated Vida Group, submitted an application to Blue Cross on behalf of Vida Group, opened a bank account, and submitted approximately $1,118,854 in fraudulent claims to Blue Cross, of which Blue Cross paid $298,038. The indictment alleges that many of the fraudulent claims were for Federal employees receiving health benefits under the Federal Employees Health Benefits Program. This case is being prosecuted by Assistant U.S. Attorney Robert Luck.

United States v. Francisco Enrique Chavez

Francisco Enrique Chavez was charged with six counts of health care fraud and three counts of aggravated identity theft in connection with his scheme to defraud the Medicare program of $11.3 million by submitting fraudulent claims for DME through World Class Medical Services, Corp., located in Miami, Florida. The indictment alleges that Chavez stole Unique Physician Identification Numbers from doctors and used those numbers to generate fraudulent claims for DME. This case is being prosecuted by DOJ Trial Attorney Sara Hall.

United States v. Maikel Villega Gorrin

Maikel Villega Gorrin is charged with five counts of health care fraud in connection with JVZ Medical Equipment, Corp., located in Hialeah, Florida. The indictment alleges that Gorrin became a signatory on JVZ’s corporate bank account, registered as president of the company, and submitted approximately $926,134 in fraudulent claims to Medicare for DME on behalf of JVZ. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

United States v. Yordany Nunez

Yordany Nunez was charged with six counts of health care fraud in connection with Med Kendall Corp., located in Miami, Florida. The indictment alleges that Nunez became the president of Med Kendall, submitted Part B and Part D Medicare applications on behalf of the company, submitted approximately $204,212 in fraudulent claims for Part B DME and $296,596 in fraudulent Part D claims for prescription drugs. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Juan Fernando Ramos

Juan Fernando Ramos was charged with one count of conspiring to commit health care fraud and thirteen counts of health care fraud in connection with P&E Medical Services, Inc., and JRD Express Services, Inc., both located in Miami, Florida. The indictment alleges that Ramos and his co-conspirators, Jose Raul Diaz and Pedro Frometa, caused the submission of approximately $4,550,391 in fraudulent Medicare claims for DME, and received payment of approximately $718,412. Finally, the indictment alleges that Ramos personally received the proceeds of the fraud. This case is being prosecuted by Assistant U.S. Attorney Robert Luck.

United States v. John Ruarte

John Ruarte was charged with six counts of health care fraud in connection with First Class Health Solutions, Inc., located in Dania Beach, Florida. The indictment alleges that Ruarte completed a Medicare application on behalf of First Class Medical Solutions, controlled a corporate bank account, and submitted approximately $1,603,536 in fraudulent Medicare claims for DME. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Tomas Solis

Tomas Solis was charged with six counts of health care fraud in connection with Ortho-America Medical Equipment, Co., Inc. (Ortho), located in Florida. The indictment alleges that Solas became the president of Ortho, maintained a Medicare provider number and bank account for Ortho, and submitted approximately $6,510,499 of fraudulent DME claims on behalf of the company. This case is being prosecuted by Assistant U.S. Attorney H. Ron Davidson.

United States v. Marta Martinez

Marta Martinez was charged with one count of conspiracy to commit health care fraud, two counts of health care fraud, and one count of conspiracy to pay health care kickbacks. The indictment alleges that, in 2005 and 2006, Martinez arranged for Medicare beneficiaries to serve as purported patients at A’s Medical Center Inc. and that she arranged for these patients to be paid. The indictment further alleges that A’s submitted more than $4 million in false claims for purported treatment of its patients, including those supplied by Martinez, based on which claims Medicare paid A’s approximately $1.1 million. This case is being prosecuted by Assistant U.S. Attorney Marc Osborne.

United States v. Armando Santos

Armando Santos was charged with one count of conspiracy to commit health care fraud, four counts of health care fraud, and two counts of making false statements related to health care matters. The indictment alleges that Santos, a Registered Nurse, caused a local home health agency to submit $230,315 in false claims to Medicare, and thereby caused Medicare to issue $152,664 in payments to the home health agency. The indictment further alleges that Santos and his conspirators caused the payment of kickbacks and bribes to Medicare beneficiaries in exchange for using their Medicare numbers as the bases of home health claims. The indictment also alleges that Santos signed patient assessment forms in which he falsely certified that home health services were medically necessary, and signed “Weekly Visit / Time Record Forms”in which he falsely stated that he was providing home health services to two separate Medicare beneficiaries at the same time. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

United States v. Yamili Rivero-Hernandez

Yamili Rivero-Hernandez was charged with three counts of health care fraud and one count of making false statements related to health care matters. The indictment alleges that Rivero-Hernandez, a Registered Nurse, caused a local home health agency to submit $317,789 in false claims to Medicare for home health services that were not rendered or that were medically unnecessary. As a result of these false claims, Medicare paid the local home health agency $208,177. According to the indictment, Rivero-Hernandez falsified “Weekly Visit / Time Record” sheets, indicating that she provided skilled nursing services to Medicare beneficiaries two times per day, seven days per week. In fact, however, she did not provide skilled nursing services with such frequency. Rivero-Hernandez allegedly also falsified paperwork in which she stated that she injected a Medicare beneficiary with insulin, when in fact, she did not do so. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

In addition to the cases being announced today, this past Tuesday, February 15, 2010, twenty individuals, including three doctors, were charged for their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services. The 38-count indictment alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all. The indictment alleges that patients for the purported services were obtained through the payment of cash kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering the patients to ATC facilities. Various defendants allegedly participated in an extensive and complicated money laundering scheme to provide the cash for kickback payments. The criminal cases are being prosecuted by Trial Attorneys Jennifer L. Saulino, Maria Gonzalez Calvet and Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The related civil action is being prosecuted by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida.

The cases announced today are being prosecuted and investigated by Strike Force teams comprised of attorneys from the Fraud Section in the Justice Department’s Criminal Division and from the U.S. Attorney Office for the Southern District of Florida. Other offices participating in today’s coordinated health care fraud takedown include the Eastern District of Michigan, the Eastern District of New York, the Middle District of Florida, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Northern District of Texas; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

An indictment is merely an accusation and defendants are presumed innocent until proven guilty.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the United States District Court for the Southern District of Florida at www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov/.

Health Care Fraud Takedown: 111 Charged Nationwide

Twenty individuals, including three doctors, were charged in South Florida earlier this week for their alleged participation in a fraud scheme involving $200 million in Medicare billing for mental health services.

And that was just a precursor to today’s national federal health care fraud takedown involving charges against 111 defendants in nine cities in connection with their alleged participation in schemes to bilk Medicare out of an additional $225 million. More than 700 law enforcement personnel from the FBI and Health and Human Services-Office of Inspector General (HHS-OIG), multiple Medicaid fraud control units, and other state and local law enforcement agencies took part in today’s operation, which was announced at a press conference in Washington, D.C.

HEAT. The Florida case and the cases involved in today’s takedown were the result of the Department of Justice/HHS Health Care Fraud Prevention and Enforcement Action Team, or HEAT, initiative and its Medicare Fraud Strike Force operating in a number of U.S. cities. In addition to Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Miami, and Tampa, Attorney General Eric Holder announced at today’s press conference the expansion of the strike force into two more cities—Chicago and Dallas.

Medicare Strike Force members include federal, state, and local investigators who use data analysis techniques to identify high-billing levels in health care fraud hot spots, targeting chronic fraud and emerging or migrating schemes by criminals masquerading as health care providers or suppliers.

In the Florida case, the indictment alleges that various defendants paid kickbacks to patient brokers and owners or operators of halfway houses and assisted living facilities for delivering patients to community mental health facilities owned by a particular corporation. The facilities would then submit claims to Medicare for services that weren’t medically necessary, or weren’t provided at all. 

The defendants charged in today’s takedown are accused of various fraud-related crimes, including conspiracy to defraud Medicare, criminal false claims, violations of the anti-kickback statutes, money laundering, and aggravated identify theft. Some of the cases include:

■Nine charged in Houston for $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care, and chiropractor services.

■Five charged in Los Angeles for a scheme to defraud Medicare of more than $28 million by submitting false claims for durable medical equipment and home health care.

■11 charged in Chicago for conspiracies to defraud Medicare of $6 million related to false billing for home health care, diagnostic testing, and prescription drugs.

In addition to our involvement with HEAT and the Medicare Fraud Strike Force, the FBI remains committed to working additional health care fraud investigations with our partners at HHS-OIG, individual state Medicare fraud offices, and investigative units from major private insurance companies. We also work jointly with the Drug Enforcement Administration, the Food and Drug Administration, and the Department of Homeland Security to address drug diversion, Internet pharmacies, prescription drug abuse, and other health care fraud threats.

We’re currently working more than 2,600 pending health care fraud investigations. During fiscal year 2010, cooperative efforts with our law enforcement partners led to charges against approximately 930 individuals and convictions of almost 750 subjects. But perhaps even more satisfying—we dismantled dozens of criminal enterprises engaged in widespread health care fraud.

This article was sponsored by Police Books.

Defrauding Medicare

Virginia Beach Doctor Sentenced to 63 Months in Prison for Defrauding Medicare and Tricare


March 16, 2010 - NORFOLK, VA—Ronald Poulin, 61, of Virginia Beach, Virginia was sentenced today in United States District Court to 63 months in prison for health care fraud, making false statements relating to health care matters, and altering records to obstruct an investigation. A Norfolk federal jury found Poulin guilty of those offenses last November following a two week trial. Neil H. MacBride, United States Attorney for the Eastern District of Virginia, made the announcement after Poulin was sentenced by United States District Judge Mark S. Davis, who also ordered Poulin to pay restitution in the total amount of $790,641.87.

Poulin is an oncologist and hematologist with a medical practice located in Virginia Beach, Virginia. The evidence presented at trial showed that between January 2006 and August 2008, Poulin filed several hundred false and fraudulent claims totaling approximately $1.3 million with the federally funded health care benefit programs Medicare and TRICARE. The billing scheme involved three components: Poulin billed for a greater amount of chemotherapy drugs than patients actually received; split single-dose 40,000 unit vials of the anemia drug Procrit between two patients and billed as if each patient had received a full vial; and billed for patient office visits which never occurred.

In addition, after being served with administrative subpoenas by the Department of Health and Human Services, Office of Inspector General and the Department of Defense, Office of Inspector General, directing him to produce certain patient and billing records as part of an investigation of his billing practices, Poulin altered the records to obstruct and influence the investigation.

“The federal government spends billions on health care, and it’s our responsibility to root out those who corrupt the system and steal from the taxpayers,” said U.S. Attorney MacBride. “Ronald Poulin lied to get more money for his services than he deserved, and now he is going to spend 63 months in prison as a result of that greed.”

The case was investigated by the Federal Bureau of Investigation, the Department of Health and Human Services, Office of Inspector General, and the Department of Defense, Office of Inspector General. Assistant United States Attorneys Katherine Lee Martin and Alan M. Salsbury prosecuted the case for the United States.