The owners and operators of several Miami home health care agencies and a patient recruiter pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Trust Care Health Services Inc. (Trust Care).
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami office; and Acting Special Agent in Charge Michael J. DePalma of the Internal Revenue Service—Criminal Investigation’s (IRS-CI) Miami Field Office made the announcement.
Roberto Marrero, 60; Sandra Fernandez Viera, 49; and Enrique Rodriguez, 59, all of Miami, pleaded guilty before U.S. Magistrate Judge Edwin G. Torres in the Southern District of Florida to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.
Marrero and Fernandez Viera were owners and operators of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Rodriguez worked as a patient recruiter on behalf of Trust Care and Marrero and Fernandez Viera.
According to court documents, Marrero and Fernandez Viera operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
Marrero largely controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company. Fernandez Viera’s primary role, among others, involved managing and supervising personnel at Trust Care. Both Marrero and Fernandez Viera were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims submitted to the Medicare program.
Marrero, Fernandez Viera and their co-conspirators paid kickbacks and bribes to patient recruiters, including Rodriguez, in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided. Marrero, Fernandez Viera and their co-conspirators at Trust Care also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation. Marrero, Fernandez Viera and their co-conspirators used these prescriptions, medical certifications and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero and Fernandez Viera knew was in violation of federal criminal laws.
Rodriguez offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing Trust Care to bill Medicare for services that were medically unnecessary and/or not provided. Rodriguez solicited and received kickbacks and bribes from the owners and operators of Trust Care, including Marrero and Fernandez Viera, in return for his patient recruiting. Rodriguez knew that in many instances the patients he recruited for Trust Care did not qualify for the services billed to Medicare.
From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services. Medicare paid Trust Care more than $15 million for these fraudulent claims.
Marrero, Fernandez Viera and Rodriguez also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million, including Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Ubieta Health System Inc., R&M Health Care Inc., Vital Care Home Health Services Inc., Centrum Home Health Care Inc. and A&B Health Services Inc.
At sentencing, scheduled for Nov. 12, 2013, the defendants face a maximum penalty of 10 years in prison for conspiracy to commit health care fraud and five years in prison for conspiracy to receive and pay health care kickbacks.
The case was investigated by the FBI and HHS-OIG, with the assistance of IRS-CI, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with 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.