Physician’s Assistant Sentenced to 14 Years in Prison for His Role in $119 Million Medicare Fraud

WASHINGTON – A Miami physician’s assistant was sentenced today to 14 years in prison in connection with his role in a $119 million HIV-infusion Medicare fraud scheme, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced.

Thomas McKenzie, 53, was sentenced today by U.S. District Judge Alan S. Gold in the Southern District of Florida. In addition to the prison sentence, Judge Gold ordered McKenzie to serve three years of supervised release following his prison term and to pay $84 million in restitution to the Medicare program.

McKenzie pleaded guilty on Sept. 18, 2008, to one count of conspiracy to commit health care fraud and one count of submitting false claims to the United States. McKenzie admitted in his plea that he trained multiple physicians how to make clinic records appear legitimate when patients had no need for infusion services. He also admitted to overseeing the documentation of fraudulent services at clinics to make them appear legitimate.

During his plea, McKenzie acknowledged that he entered into an agreement with Carlos and Luis Benitez starting in December 2001 to assist the Benitez brothers in operating fraudulent HIV infusion clinics throughout Miami-Dade County. McKenzie admitted that the Benitez brothers would obtain patients and have staff members pay them cash kickbacks to participate in the scheme. In turn, McKenzie admitted he trained and oversaw the physicians working at the clinics to ensure that medical records appeared to support the treatments being billed to Medicare. McKenzie admitted that the treatments were medically unnecessary and many were never provided.

McKenzie was indicted with co-defendants Carlos, Luis and Jose Benitez on June 11, 2008. The indictment alleges that Carlos, Luis and Jose Benitez were the masterminds of a $100 million fraud that involved at least 11 different Miami clinics: AH Medical Office Inc. (AH Medical), Best Medi Inc. (Best Medi), Physicians-Health Med-Care (PHMC), Physicians Med-Care Inc. (PMC), Saint Jude Rehab Center Inc. (Saint Jude), Global Med-Care Inc. (Global), CNC Medical Office Inc. (CNC), G&S Medical Center Inc. (G&S), Karla Medical Services Inc. (Karla Medical), Best Medicare Inc. (Best Medicare) and Advanced Medical Rehabilitation Services. All three Benitez brothers remain at large.

An indictment is merely a charge, and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt.

In addition to McKenzie, 13 co-conspirators have either pleaded guilty or been found guilty for their roles in the Benitez brother’s HIV infusion scheme:

On Aug. 28, 2007, medical biller Rita Campos Ramirez pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the United States, in connection with her role as medical biller for the Benitez brothers’ clinics and other HIV infusion clinics. In pleading guilty, Campos Ramirez admitted to submitting approximately $170 million in fraudulent claims to the Medicare program for HIV infusion and related services. On March 26, 2008, Campos Ramirez was sentenced to 10 years in prison.
On Aug. 26, 2008, Ronald Harris, M.D., pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks, one count of conspiracy to commit health care fraud, and three counts of false claims, in connection with his role as medical director and physician at PMC and PHMC. On Nov. 4, 2008, Harris was sentenced to seven years in prison.
On Sept. 11, 2008, Carlos Contreras, M.D., pleaded guilty to one count of conspiracy to commit health care fraud in connection with his role as an owner and doctor at CNC. Contreras was sentenced to 37 months in prison on Nov. 20, 2008.
On Sept. 11, 2008, Ramon Pichardo, M.D., pleaded guilty to one count of conspiracy to commit health care fraud, in connection with his role as doctor at CNC. Pichardo was sentenced to four years in jail on Nov. 20, 2008.
On June 12, 2007, Orestes Alvarez-Jacinto, M.D., pleaded guilty to one count of conspiracy to commit health care fraud, in connection with his role as medical director and doctor at Saint Jude. On Oct. 2, 2007, Alvarez-Jacinto was sentenced to 18 months in prison.
On April 23, 2008, Aisa Perera pleaded guilty to one count of conspiracy to commit health care fraud, in connection with her role as the co-administrator of Saint Jude. On July 10, 2008, Perera was sentenced to 30 months in prison.
On Aug. 26, 2008, Mariela Rodriguez pleaded guilty to one count of conspiracy to commit health care fraud and one count of making a false declaration before the grand jury, in connection with her role as co-administrator of Saint Jude. Rodriguez was sentenced to 70 months in prison on Nov. 4, 2008.
On Sept. 9, 2008, Dilcia Marinez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, in connection with her role as president and director of G&S. Marinez was sentenced to 57 months in prison on Nov. 18, 2008.
On Aug. 29, 2008, Juan Carlos Castaneda pleaded guilty to one count of conspiracy to commit money laundering, in connection with his role in laundering approximately $4 million for G&S and another medical clinic. Castaneda was sentenced to 87 months in prison on Nov. 18, 2008.
On Sept. 23, 2008, Luis Frias pleaded guilty to one count of conspiracy to commit money laundering in connection with his role in laundering approximately $550,000 in Medicare proceeds at G&S. Frias was sentenced to 27 months in prison on Nov. 18, 2008.
On Aug. 28, 2008, Nayda Freire pleaded guilty to one count of conspiracy to commit health care fraud, in connection with her role as president and registered agent of Global. Freire was sentenced to 30 months in prison on Nov. 12, 2008.
On Oct. 17, 2008, after a two-week jury trial, Ana Alvarez-Jacinto, M.D., was convicted of one count of conspiracy to defraud the United States, to submit false claims, and to pay health care kickbacks, one count of conspiracy to commit health care fraud, and three counts of submitting false claims to the Medicare program at Saint Jude, where she worked as a physician. On Dec. 17, 2008, Alvarez-Jacinto was sentenced to 30 years in prison.
Also on Oct. 17, 2008, Sandra Mateos, Luis Benitez’ ex-wife, was convicted of one count of conspiracy to defraud the United States, to submit false claims, and to pay health care kickbacks, and one count of conspiracy to commit health care fraud at Saint Jude, where she worked as a nurse. On Dec. 17, 2008, Mateos was sentenced to seven years in prison.

The case was prosecuted by Assistant Chief Hank Bond Walther and Trial Attorney John K. Neal of the Criminal Division’s Fraud Section and investigated by the FBI and the Department of Health and Human Services, Office of the Inspector General. The case was brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Since the inception of MFSF operations, federal prosecutors have indicted 106 cases with 188 defendants in both Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

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