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Thursday, April 16, 2015

Owner of Miami Home Health Company Sentenced to 113 Months in Prison for $32 Million Medicare Fraud Scheme

An owner of a Miami home health care company was sentenced today to 113 months in prison in connection with a $32 million Medicare fraud scheme.

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 Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement. 

Felix Gonzalez, 45, of Miami, pleaded guilty on Jan. 9, 2015, to one count of conspiracy to commit health care fraud, and was sentenced today by U.S. District Judge Kathleen M. Williams of the Southern District of Florida.  In addition to the prison sentence, Gonzalez was ordered to pay $21,423,160 in restitution.

Gonzalez was an owner of AA Advanced Care Inc. (AA Advanced), a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries.  As part of his guilty plea, Gonzalez admitted that he and his co-conspirators operated AA Advanced 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 or not provided at all.

Gonzalez further admitted that he negotiated and paid kickbacks and bribes to patient recruiters in exchange for patient referrals, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.  Gonzalez admitted that he and his co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services.

From approximately January 2006 through March 2009, AA Advanced submitted approximately $32 million in claims for home health services that were not medically necessary or not provided, and Medicare paid approximately $22 million for these fraudulent claims.

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.  This case is being prosecuted by Assistant Chief Joseph S. Beemsterboer and Trial Attorneys Kelly Graves and Lisa Miller 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 nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion.  In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is 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.

Health Care Fraud
Press Release Number: 
Updated April 16, 2015