Miami Physician Indicted for Role in $20 Million Health Care Fraud Scheme
A Miami physician was charged in an indictment unsealed today with participating in a Medicare fraud scheme that caused losses of more than $20 million.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.
Henry Lora, M.D., 51, of Miami, was charged with one count of conspiracy to commit health care fraud and wire fraud; and one count of conspiracy to defraud the United States, receive health care kickbacks and make false statements relating to health care matters.
According to allegations in the indictment, Lora and Isabel Medina owned and operated Merfi Corporation (Merfi), a Miami-area clinic that employed physicians, physician assistants and other medical professionals. The indictment alleges that, in exchange for kickbacks and bribes, Lora and his co-conspirators wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary or not provided. Lora and his co-conspirators allegedly falsified patient records to make it appear as if the beneficiaries qualified for the services for which Medicare was billed.
According to the indictment, the alleged actions of Lora and his co-conspirators prompted multiple Miami-Dade home health care agencies and other providers to bill Medicare for services that were not medically necessary or not provided. Medicare made payments on these fraudulent claims.
Medina pleaded guilty to conspiracy to commit health care fraud and was sentenced in March 2014 to nine years in prison. Medina admitted that her activities and those of her co-conspirators at Merfi caused losses to the Medicare program exceeding $20 million.
The charges and allegations contained in an indictment are merely accusations. The defendant is presumed innocent unless and until proven guilty.
The case was investigated by the FBI and HHS-OIG, 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 of the Southern District of Florida. This case is being 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 over 2,300 defendants who collectively have billed the Medicare program for over $7 billion. In addition, the HHS Centers for Medicare & 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.