[Miami, FL] It would appear that the U.S. Government is cracking down on Medicare fraud in a big way, as evidenced by the slew of indictments, convictions and sentences coming out of a federal courtroom in Miami.
In just twelve short days, the United States Attorney’s Office for the Southern District of Florida has press-released four closed, ongoing or recently opened cases involving Medicare fraud totaling hundreds of millions of dollars.
The aggressive action is welcome – the federal government’s Medicare program has long been a target of unscrupulous individuals looking to file false claims and systematically steal from the taxpayers for personal gain.
Here are the U.S. Attorney’s actions so far this month:
Nelson Fernandez, 42, a Miami-area resident, pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.
The two separate fraud schemes that resulted in the submission of more than $200 million in fraudulent claims to Medicare. Sentencing for Fernandez is scheduled for Jan. 17, 2012. Fernandez faces a maximum penalty of 15 years in prison and a $250,000 fine.
Lawrence Duran, Marianella Valera and Margarita Acevedo have also pleaded guilty for their roles in the scheme. They are scheduled to be sentenced in September. The trial against Judith Negron, is scheduled to begin next week.
The indictment charging Fernandez also charges 17 other individuals for their roles in the fraud scheme. Co-defendants Dr. Alan Gumer, Joseph Valdes, James Edwards and Adrianna Mejia have all pleaded guilty for their roles in the scheme. Trial against the remaining 13 co-defendants is scheduled to begin in November.
Gilbert Sanabria, Jr., of Hollywood has been arrested and indicted on charges of conspiracy to commit health care fraud, conspiracy to commit bribery and bribery. Sanabria, Jr., operated a Broward corporation that sold and/or brokered the sale of medical clinics to others, who would in turn submit false claims to Medicare.
These clinics subsequently submitted approximately $27,991,634 in false claims to Medicare, of which Medicare paid approximately $9,536,298.
The false claims were for durable medical equipment including varicose vein treatments, pain management services and physical therapy.
The purchasers of these clinics had previously pled guilty to charges including conspiracy to commit health care fraud, health care fraud, money laundering, and aggravated identity theft and are currently serving sentences ranging 37 months to 235 months.
In addition, Sanabria, Jr., allegedly provided cash and valuables to a Medicare contractor employee in exchange for expedited approvals for Medicare enrollment applications and other paperwork for the fraudulent clinics. That employee has been charged with conspiracy to receive bribes.
Chief U.S. District Judge Federico Moreno sentenced Armando Santos, 46, of Miami to the maximum of 10 years imprisonment for conspiracy to commit health care fraud, four counts of health care fraud and making false statements.
Santos was a home care nurse servicing homebound, diabetic and insulin dependent Medicare patients. Santos falsified documents claiming that he injected beneficiaries with insulin when the evidence produced in court proved otherwise, as well as treating two patients at one time at different locations.
Those false reports resulted in the submission of $230,315 in false claims to Medicare.
The owners of the home-care company, Elizabeth Acosta Sanz and Luis Alejandro Sanz, both of Miami, were recently arrested and charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay kickbacks, the payment of kickbacks, conspiracy to commit money laundering, and money laundering.
The husband and wife team submitted fraudulent claims and paid kickbacks to recruiters and others. The pair also instructed nurses to falsify patient medical records. Many of those services were unnecessary or had not been provided.
The Sanzes submitted approximately $11,340,342 in false claims to Medicare, of which Medicare paid $7,317,879.
A federal grand jury in Miami indicted Elizabet Lombera, 39, of Miami Lakes on multiple counts of health care fraud for submitting bogus claims to Medicare. Five companies that she ran submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements.
If convicted, Lombera faces a possible maximum of 10 years in prison for the conspiracy and fraud counts and two-year mandatory minimum for identity theft.
Six of Lombera’s co-conspirators have already been sentenced for their roles in the crime. Four other individuals have been charged for their roles in laundering the proceeds of the health care fraud and are awaiting trial.
By: Mark Christopher/Sunshine Slate