Miami-Area Doctor Pleads Guilty in $25 Million Health Care Fraud Scheme

WASHINGTON – A Miami-area medical doctor who owned two medical offices pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, FBI and the Department of Health and Human Services (HHS).

Jose Nunez, 63, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. According to plea documents, Nunez provided home health care and therapy prescription referrals to ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.

Nunez admitted that he knew co-conspirators at ABC and Florida Home Health operated the agencies in order to bill the Medicare program for expensive physical therapy and home health care services that were medically unnecessary and/or were never provided. The medically unnecessary services were prescribed by Nunez and other doctors.

According to court documents, beginning in approximately January 2006, and continuing until approximately March 2009, Nunez prescribed medically unnecessary services, including home health and therapy prescriptions, plans of care and medical certifications in exchange for kickbacks and bribes. The kickbacks and bribes were paid to Nunez by nurses, patient recruiters and the owners and operators of ABC and Florida Home Health. According to plea documents, Nunez furthered the scheme by falsifying patient files with descriptions of non-existent medical conditions for the Medicare beneficiaries, including hand tremors, unsteady gait and poor vision. These symptoms were included to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under the Medicare program. Nunez knew that the files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Nunez’s participation in the illegal scheme, the Medicare program was billed approximately $1.5 million for purported home health care services that were medically unnecessary and/or were never provided.

Three other co-conspirators – Lisandra Alonso, Luisa Morciego and Vicente Guerra – have pleaded guilty for their roles in the fraud scheme.

Sentencing has been scheduled for Dec. 5, 2011.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also faces fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.

Today’s guilty plea was 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 Florida.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov .