Miami Physician Pleads Guilty for Role in $20 Million Health Care Fraud Scheme
A Miami physician pleaded guilty today for his role in a Medicare fraud scheme that caused more than $20 million in losses.
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 Division and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Miami Regional Office made the announcement.
Henry Lora, 51, of Miami, pleaded guilty before U.S. District Judge Federico A. Moreno of the Southern District of Florida to one count of conspiracy to commit health care 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 the factual basis of the plea agreement, Lora was the medical director of Merfi Corporation, a Miami-area clinic that employed physicians, physician assistants and other medical professionals. Lora admitted that in exchange for kickbacks and bribes, he 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 also falsified patient records to make it appear as if the beneficiaries qualified for these services, he admitted.
Lora admitted that his and his co-conspirators’ actions caused multiple Miami-Dade home health care agencies and other providers to bill Medicare for services that were not medically necessary or not provided, and Medicare made payments on these fraudulent claims.
In March 2014, Isabel Medina, the owner of Merfi, was sentenced to nine years in prison for conspiracy to commit health care fraud.
The FBI and HHS-OIG investigated the case, which 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. Fraud Section Trial Attorney A. Brendan Stewart is prosecuting the case.
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.