Fifty-Nine South Florida Residents Charged as Part of Nationwide Coordinated Takedown by Medicare Fraud Strike Force Operations

May 3, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

107 Individuals Charged Nationally for Submitting Approximately $452 Million in Fraudulent Billing; South Florida Responsible for more than $137 Million in False Billings

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; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); and Henry Gutierrez, Postal Inspector in Charge, U.S. Postal Inspection Service, Miami Division, announced that 59 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare out of more than $137 million. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that resulted in charges against 107 individuals, including doctors, nurses and other licensed professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud. Approximately 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the national takedown.

U.S. Attorney Wifredo A. Ferrer stated, “The Medicare program is a valuable and limited trust fund to provide much needed services for the poor, the elderly and the sick. Among the dozens of fraudsters charged in South Florida in this operation are clinic owners, nurses, therapists, patient recruiters, pharmacy owners, accountants, former social workers, and even beneficiaries, all of whom stole precious health care dollars through a variety of schemes. These get rich quick schemes at the expense of the most vulnerable in our society are unacceptable. We will continue to fight health care fraud on all fronts: we will prosecute each link in the fraud chain and each evolving fraud scheme.”

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

“More than half of those charged in a record setting health care fraud takedown today were from the Miami area. The local fraud totaled more than $137 million. Sadly, in Miami, multi-million-dollar health care fraud cases are no longer shocking in their magnitude or frequency,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “Here’s my message clear and simple: you can run, but as evidenced by today’s nationwide takedown, you can’t hide.”

“Medicare fraud diverts precious resources from those who are eligible and need it most,” said Christopher B. Dennis, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s region covering Florida. “Today’s action should send a strong message that we will continue to track the evidence to ensure that those involved are held accountable.”

U.S. Postal Inspector in Charge Henry Gutierrez stated, “Medicare fraud is an assault on resources for our most needy and vulnerable citizens. This joint effort by the South Florida law enforcement community demonstrates that those who engage in these illegal schemes will be prosecuted to the full extent of the law.”

The South Florida defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, and physical and occupational therapy. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.

Specifically, the South Florida cases announced as part of the nationwide Medicare Fraud Strike Force takedown include:

U.S. v. Odalys Fernandez, Kelvin Soto, Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya, Case No. 12-20230-CR-Ungaro

In this six-defendant case, two registered nurses employed by Ideal Home Health (Odalys Fernandez and Kelvin Soto) are charged with conspiracy to commit health care fraud for purportedly providing services, such as skilled nursing and physical therapy, to homebound beneficiaries. In fact, however, the services were either medically unnecessary or were never provided. As part of the scheme, the defendants falsified medical paperwork to make it appear as if they had provided the services. Four other defendants (Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya) are alleged to be patient recruiters who paid Medicare beneficiaries so they would serve as patients at Ideal Home Health. Ideal, in turn, submitted more than $40 million in false billings to Medicare. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

U.S. v. Eulises Escalona, Case No. 12-20293-CR-Lenard

This indictment charges Eulises Escalona with one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to receive and pay health care kickbacks, and five counts of payment of health care kickbacks stemming from a $42 million home health care fraud scheme. According to the indictment, Escalona owned and operated Willsand Home Health, Inc. (Willsand), a home health agency that purportedly provided home health and physical therapy services to eligible Medicare beneficiaries. In fact, however, from January 2006 through November 2009, Escalona and others paid kickbacks to Medicare beneficiaries to induce them to become patients at Willsand regardless of medical need and to falsely attest that they had received the purported services. In addition, Escalona and others paid kickbacks to patient recruiters and to doctors who signed fraudulent prescriptions and plans of care (POCs) for unnecessary home health services for patients at Willsand. To execute the scheme, Escalona and others falsified patient files and POCs to make it appear as if the patients had qualified for and actually received home health services. In this way, Willsand allegedly submitted approximately $42 million in false claims to Medicare for services it claimed to have provided to approximately 622 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Rodolfo Nieto, Jr., Case No. 12-20290-CR-Altonaga

This indictment charges Rodolfo Nieto, Jr., owner and operator of Ronat Home Health Care, Inc. (Ronat), with one count of conspiracy to defraud the United States and to receive and pay health care kickbacks and three counts of receipt of kickbacks for his participation in a $60 million home health care fraud scheme. According to the indictment, from January 2006 through November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries for placement at Nany Home Health, Inc. (Nany). Nieto allegedly caused Nany to submit claims to Medicare for home health services, including insulin injections and physical therapy, purportedly provided through Ronat. According to the indictment, Nany submitted approximately $60 million in false claims to the Medicare program for services that it purportedly provided to approximately 1474 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Maggie Leon, Yuderkis Pena Garcia and Eduardo Vilau, Case No. 12-20274-CR-Seitz

In this case, defendants Maggie Leon, Yuderkis Pena Garcia, and Eduardo Vilau, owners of Leon Medical and Leah Medical, were charged with conspiracy to commit health care fraud and health care fraud for submitting false claims to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. As alleged in the indictment, the defendants submitted approximately $1,826,000 in false claims for expensive cancer and HIV injections that were not medically necessary and were not actually provided to the Medicare beneficiaries. In addition, the indictment alleges that the defendants conspired to pay kickbacks to Medicare beneficiaries so that they would serve as patients at Leah and Leon. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Ricardo Martinez, Case No. 12-20316-CR-Martinez

This indictment charges defendant Ricardo Martinez with health care fraud and paying kickbacks to patients. The indictment alleges that the defendant paid kickbacks and bribes to beneficiaries so that they would serve as patients at Rima Medical. The indictment further alleges that Martinez, through Rima Medical, submitted approximately $1,706,701 in false claims for expensive cancer and HIV injections to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Yaquelin Colls, Pedro Colls, and Jesus Fernandez, Case No. 12-20315-CR-Seitz

This indictment charges defendants Yaquelin Colls, Pedro Colls, and Jesus Fernandez with conspiracy to commit health care fraud, substantive health care fraud, conspiracy to pay health care kickbacks, and substantive charges of paying kickbacks. More specifically, the indictment alleges that the defendants owned and operated Ma Medical and Therapy Services, Inc. (Ma Medical), and caused the submission of $972,068 in false medical claims for expensive cancer and HIV injections to a private insurance company that was a Medicare Advantage provider under Part C of the Medicare program. In a similar scheme, the defendants submitted $55,642 in false claims to another private insurance company under Part C of the Medicare program through a second clinic, Healthy Touch Rehab Center Inc. (Healthy Touch), which they also owned and operated at the same address as Ma Medical. The indictment further alleges that the defendants conspired to pay kickbacks and bribes to beneficiaries so that they would serve as patients at Ma Medical and Healthy Touch. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Roberto L. Valdes Gonzalez, Francisca Gema Valdez, Gilberto Faure, and Alberto Sotolongo, Case No. 12-20275-CR-Moore

In this case, defendants Jose L. Valdes Gonzalez, a/k/a “Roberto Gonzalez,” Alberto Sotolongo, a/k/a “Ruben,” Gilberto Faure, and Francisca Gema Valdes were charged with conspiracy to commit health care fraud and substantive counts of health care fraud in connection with the operation of Ilva Pharmacy, Inc. More specifically, the indictment alleges that between 2009 and 2011, the defendants caused Ilva Pharmacy to submit approximately $1.3 million in false claims for prescription drugs that were not provided to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. The indictment additionally charges Gonzalez and Sotolongo with offering and paying kickbacks to Medicare beneficiaries to induce them to serve as patients at Ilva Pharmacy. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Alina De Armas, Case No. 12-20282-CR-Zloch

In this case, defendant Alina De Armas is charged with health care fraud and with paying kickbacks to patients. The information alleges that De Armas offered and paid kickbacks to Medicare beneficiaries to induce them to serve as patients at Ultratech Medical Supplies, Inc., d/b/a Guines Pharmacy. In this way, from 2007 through 2011, De Armas caused the submission through Guines Pharmacy of approximately $3.6 million in false claims for prescription drugs to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Isaura Bou-Melendez and Gricel Font, Case No. 12-20113-CR-MGC

In this case, Isaura Bou-Melendez and Gricel Font are charged with conspiracy to commit health care fraud. Bou and Font, licensed therapists, owned and operated a comprehensive outpatient rehabilitation facility, Font & Bou Rehab Associates, Inc. The information alleges that from January 2006 through February 2010, Font and Bou allegedly submitted approximately $6.9 million in false claims to Medicare for physical and occupational therapy services that were not medically necessary or not provided as claimed. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Maritza Claudia Fernanda Lorza Ramirez, and James Arley Velasco Gonzalez, Case No. 12-60090-CR-KMW

This indictment charges defendants Maritza Lorza Ramirez and James Velasco Gonzalez with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between January 2006 and December 2010, Lorza and Velasco laundered approximately $3 million in health care fraud proceeds for several companies using their own corporations, including Celebration Home Services, Inc., 4 All Your Needs, Inc., VPP Staffing, Inc, and Work Force Innovations, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Orlando Conrado Piedra Jr., Case No. 12-60091-CR-KMW

This indictment charges Orlando Piedra, an accountant, with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between June 2007 and September 2009, Piedra laundered approximately $500,000 in health care fraud proceeds for several companies through his own company, Media Health Consultants, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, Serena Joslin, Ivon Perez, Daniel Martinez, Raymond Rivero, Case No. 12-20291-CR-Altonaga

Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, and Serena Joslin are charged with one count of conspiracy to commit health care fraud through a company called Health Care Solutions Network (HCSN). Additionally, defendants Gonzalez, Daniel Martinez, Raymond Rivero, and Ivon Perez are charged with conspiracy to receive and pay health care kickbacks; defendants Martinez, Rivero, and Perez are charged with substantive counts of soliciting and receiving health care kickbacks; defendants Gonzalez and Thoen are charged with one count of conspiracy to commit money laundering; and defendant Gonzalez is charged with substantive counts of money laundering. More specifically, the indictment alleges that between November 2004 and March 2011, Gonzalez, Thoen, Eason, Layman, Haynes, and Joslin conspired to submit approximately $63 million in false claims to Medicare and Medicaid for mental health services that were neither necessary nor provided. The indictment also alleges that Gonzalez conspired with owners of Assisted Living Facilities (ALFs), including Martinez, Rivero, and Perez to pay and receive health care kickbacks in exchange for referring Medicare beneficiaries to HCSN. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Sarah Da Silva Keller, Case No. 12-20289-CR-Cooke

Sarah Da Silva Keller is charged with one count of conspiracy to commit health care fraud. More specifically, the criminal information alleges that between April 2006 and February 2008, Keller conspired with others at HCSN to submit false claims to Medicare for mental health services that were neither medically necessary nor provided. The information further alleges that HCSN submitted approximately $63 million in false claims to Medicare. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Alba Serrano, Case No. 12-20285-CR-Seitz

Alba Serrano is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Serrano, the owner of Elsa’s House of the Elderly, a Miami-Dade ALF, referred residents from her ALF to American Therapeutic Corporation (ATC) in exchange for kickbacks. ATC was a Community Mental Health Center (CMHC) that submitted false claims for intensive mental health services, called Partial Hospitalization Program, based on Serrano’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Bobby Ramnarine, Case No. 12-20288-CR-Middlebrooks

Bobby Ramnarine is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Ramnarine, the owner of Elmina’s ALF, in Broward County, recruited residents from Elmina’s to become patients at ATC in exchange for kickbacks. ATC submitted false claims for PHP services based on Ramnarine’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Giuseppe Pellerito, Case No. 12-20292-CR-Cooke

In this case, defendant Giuseppe Pellerito is charged with conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks. The indictment alleges that Pellerito, the owner of Florida Sober House (FSH), received kickbacks for recruiting residents from FSH to become patients at ATC. ATC, in turn, submitted false claims for PHP based on Pellerito’s referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Hassan Collins, Case No. 12-20286-CR-Moore

Hassan Collins is charged with one count of conspiracy to pay and receive health care kickbacks. According to the criminal information, Collins was the owner of New Way Recovery Inc. (NWR), which operated several halfway houses in Broward County. Collins allegedly received kickbacks for recruiting Medicare beneficiaries who resided at NWR to become patients at ATC. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Jean Luc Veraguas, Case No. 12-20287-CR-Moreno

Jean-Luc Veraguas is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Veraguas was the owner of Neu Ways Inc., which operated several halfway houses in Broward County. Veraguas allegedly referred residents at his houses to ATC in exchange for kickbacks. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Pablo Orama, Vivian Augustine, a/k/a Vivian Salazar, Ariane Marchioro Amorim, Jose Orelvis Ortega, Marlen Diosdada Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba M. Caicedo, Carlos A. Herrera, Marisela Sherwood, Nancy Diaz, Daymi Fuentes Gil, Olga Martinez Rodriguez, Yuria Perez Rivero, and Joel Loyola, Case No. 12-20265-CR-Middlebrooks(s)

In this case, 16 defendants are charged with conspiracy to pay and receive health care kickbacks and substantive counts of paying and receiving kickbacks in connection with a federal health care program. According to the indictment, defendant Pablo Orama was the owner of Superstar Home Health, a Miami-Dade County home health agency that purportedly provided skilled nursing services and physical therapy to homebound Medicare beneficiaries. Vivian Augustine and Ariane Amorim were employees of the company. Jose Orelvis Ortega, Marlen Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba Caicedo, Carlos Herrera, Marisela Sherwood, and Nancy Diaz were recruiters who offered money to Medicare beneficiaries in return for their agreement to serve as patients at Superstar. Defendants Daymi Fuentes Gil, Olga Rodriguez, Yuria Rivero, and Joel Loyola were Medicare beneficiaries who accepted kickbacks in return for agreeing to serve as patients at Superstar. This case is being prosecuted by Assistant U.S. Attorney Eric E. Morales.

U.S. v. Jorge Luis Reyes and Waldo Gonzalez, Case No. 12-14030-CR-Moore

This indictment charges Jorge Luis Reyes and Waldo Gonzalez, owners of a medical clinic that purported to treat HIV-positive Medicare beneficiaries at locations in Miami-Dade and St. Lucie Counties. According to the indictment, between November 2005 and January 2009, the defendants submitted approximately $15,201,162 in fraudulent claims to Medicare for treatment that was not provided, and in many cases would not have been medically necessary. The majority of the fraudulent claims (more than $13.6 million) were submitted to private insurance companies that were a Medicare Advantage contractor under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Marc Osborne.

U.S. v. Manotte Bazile, Case No. 12-20284-CR-Lenard

Defendant Manotte Bazile, a former social worker and licensed intern at Biscayne Milieu, was charged with health care fraud conspiracy for purportedly treating patients who did not qualify for PHP treatment. This case is part of larger indictment involving of Biscayne Milieu, a CMHC that was involved in the submission of $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for or receive the treatments that were billed to Medicare. In this case, Bazile assisted non-U.S. citizen patients by completing immigration forms on their behalf that falsely indicated that the patients suffered from mental illnesses, thereby fraudulently enabling the patients to avoid taking the citizenship test. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

U.S. v. Roselyn Nicole Charles, Case No. 12-20283-CR-Ungaro

Defendant Roselyn Nicole Charles, a former patient recruiter at Biscayne Milieu, was charged with conspiracy to pay health care fraud kickbacks. More specifically, the criminal information alleges that Charles recruited patients to participate in Biscayne Milieu’s PHP in exchange for kickbacks. These patients, who did not qualify for PHP treatment, were promised assistance with their U.S. citizenship applications in exchange for their participation in Biscayne Milieu’s PHP. This case is part of larger indictment of Biscayne Milieu, a CMHC that was involved in the submission of more than $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for PHP treatment or receive the treatments that were billed to Medicare. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. Miami was the first Strike force city in the nation, and the model for others that followed.

An indictment or information is only 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 http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.”

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Douglas McNabb – McNabb Associates, P.C.’s
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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


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