WASHINGTON – A medical doctor, a clinic owner and four nurses, all South Florida residents, pleaded guilty today before U.S. District Judge Adalberto Jordan in U.S. District Court in Miami for their participation in a fraudulent Medicare home health care scheme, the Departments of Justice and Health and Human Services (HHS) announced. Another nurse pleaded guilty on Aug. 25, 2010, to charges for her role in the scheme. The individuals were originally charged in a December 2009 indictment.
Dr. Fred Dweck pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patient files. According to plea documents, Dr. Dweck admitted to referring 858 Medicare recipients for unnecessary home health care services. Specifically, Dr. Dweck admitted to signing prescriptions, plans of care and medical certifications for these patients, making it appear that they qualified for home health care services, when in fact they did not qualify for the services. The services included therapy and skilled nursing visits for purported diabetic insulin injections. As a result of Dr. Dweck’s referrals, Miami-area home health care agencies billed the Medicare program for more than $37 million in false and fraudulent claims. Medicare paid more than $22 million of the fraudulent claims.
Dr. Dweck’s co-defendant, Yudel Cayro, pleaded guilty to one count of conspiracy to commit health care fraud. According to plea documents, Cayro admitted to being an owner and operator of Courtesy Medical Group Inc., a Miami-area clinic that employed Dr. Dweck. Cayro admitted that he received kickbacks and bribes from people who recruited Medicare recipients into the scheme and from the owners and operators of Miami-area home health agencies in return for having Dr. Dweck issue prescriptions, plans of care and medical certifications for unnecessary home health care and therapy services. Cayro admitted that approximately 344 Medicare recipients were referred for such unnecessary services through his clinic, resulting in more than $16 million of fraudulent billing to the Medicare program by home health agencies. Medicare paid approximately $9.8 million for medically unnecessary home health care and therapy services.
Nurses Teresita Leal, Armando Sanchez, Lissbet Diaz, Marlenys Fernandez and Silvio Ruiz each pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patient files. According to court documents, each of the nurses worked at various times for ABC Home Health Care Inc. and/or Florida Home Health Care Providers Inc., two Miami-area home health care agencies. The nurses admitted to falsifying patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. The nurses admitted that they did so in agreement with their co-conspirators so that the Medicare program could be billed for medically unnecessary services. The owners and operators of ABC and Florida Home Health pleaded guilty last year in a separate case for their roles in the scheme. According to court documents, each nurse accepted responsibility for the billings to the Medicare program for certain patients each nurse purported to treat through ABC and/or Florida Home Health.
At sentencing, set for December 2010, each defendant faces a maximum of 10 years in prison for each conspiracy to commit health care fraud count and five years in prison for each false statement count.
Today’s guilty pleas were 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 cases are being prosecuted by Trial Attorneys N. Nathan Dimock, Sam Sheldon and Henry Van Dyck, with assistance from Trial Attorneys Sarah Hall and Joe 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 its inception in March 2007, the Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 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.