Operator of Miami HIV Clinic Sentenced to 57 Months in Prison for Role in Medicare Fraud Ring

WASHINGTON – Jose Garcia, 55, was sentenced today in U.S. District Court in Miami to 57 months in prison for his participation in a Medicare fraud scheme involving a Miami-area HIV clinic, the Departments of Justice and Health and Human Services (HHS) announced.

U.S. District Judge Adalberto Jordan also ordered Garcia to serve three years of supervised release and ordered him to pay, jointly and severally with his co-conspirators, restitution of $7,992,391.

Garcia was indicted in 2008 and was a fugitive for nearly two years before surrendering to FBI agents in May 2010. Garcia pleaded guilty in August 2010 to one count of conspiracy to cause the submission of false claims to the Medicare program and to pay health care kickbacks; and one count of conspiracy to commit health care fraud.

According to court documents, Garcia operated Global Med-Care Corp. Inc., a medical clinic in Miami that purported to specialize in treating patients with HIV. Garcia, his co-defendant Nayda Freire and others caused Global Med-Care to submit claims to the Medicare program for expensive HIV medication that was medically unnecessary or never provided. In return for a share of Global Med-Care’s profits, Garcia and Freire agreed with their co-conspirators to oversee the staff necessary to operate Global Med-Care; the Medicare patients whom Global billed to the Medicare program; and the transportation for the patients. Garcia admitted he knew that Global Med-Care would need to pay kickbacks to its patients and that Global Med-Care could bill Medicare for HIV infusion services three times a week, for up to three months, for each patient. Garcia also admitted that from April 2003 through August 2003, Global Med-Care submitted approximately $10.9 million in claims to the Medicare program for HIV infusion services that were never provided and/or medically unnecessary.

Freire pleaded guilty in August 2008 to one count of conspiracy to defraud the Medicare program, and was sentenced by Judge Jordan on Nov. 12, 2008, to 30 months in prison.

Freire admitted that after payments from Medicare were made into the bank accounts of Global Med-Care, she and others transferred approximately $6 million of the fraud proceeds to sham management, marketing and investment companies owned and operated by co-conspirators Carlos, Luis and Jose Benitez. Carlos, Luis and Jose Benitez and Thomas McKenzie were charged separately with health care fraud and other related crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, these co-conspirators allegedly provided the money and staff necessary to open Global Med-Care; the Medicare patients whom the clinic would bill to the Medicare program; and transportation for the HIV patients who visited the clinic. That indictment also alleges that Carlos and Luis Benitez were the true owners of Global Med-Care.

The three Benitez brothers and McKenzie were charged with participating in the commission of approximately $109 million in HIV infusion fraud and money laundering through Global Med-Care and 10 other HIV infusion clinics. On Sept. 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program, and also admitted his role in a $119 million HIV infusion fraud scheme. McKenzie was sentenced by U.S. District Judge Alan S. Gold on Dec. 18, 2008, to 14 years in prison in connection with his role in the HIV infusion Medicare fraud scheme. In addition to the prison sentence, McKenzie was ordered to pay $84 million in restitution to the Medicare program. The Benitez brothers remain fugitives. An indictment is merely an accusation and the Benitez brothers remain innocent until proven guilty in a court of law.

Today’s sentence 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.

The case was prosecuted by Deputy Chief Hank Bond Walther and Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section, and was investigated by the FBI and HHS-OIG. The case 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 seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for approximately $2 billion. In addition, HHS’s 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 .