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Thursday, March 17, 2016

Owner of Two Miami Clinics Sentenced to 82 Months for Health Care Fraud Charges

An owner of two fraudulent medical clinics in the Miami area was sentenced to 82 months in prison today for his role in a Medicare fraud scheme that caused more than $3 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.

Carlos Medina, 56, of Miami, pleaded guilty before U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida to one count of conspiracy to commit health care fraud in January 2016.  In addition to his prison sentence, Judge Altonaga ordered Medina to forfeit $3,067,898.69.

According to admissions in the factual basis for his plea agreement, Medina was the owner of Doral Community Clinic Inc. and Advanced Medical of Doral Inc., however, other individuals served as the owners on the clinics’ corporate paperwork.  Medina’s clinics purportedly provided medically necessary services to Medicare beneficiaries, but in reality the clinics charged cash kickbacks ranging from $100 to $200 in exchange for prescriptions for home health care services, and some of the beneficiaries who frequented the clinics did not meet Medicare’s criteria for the prescribed services, according to the factual basis.  Some of the services prescribed by the medical professionals at Doral and Advanced Medical were never provided by the home health agencies to which the patients were referred, according to admissions in the factual basis. 

The factual basis for the plea agreement states that Medina’s clinics sold prescriptions that were used to facilitate submission of false and fraudulent claims to Medicare by more than 20 home health agencies in the Miami area.  Medicare paid more than $3 million in payments as a direct result of prescriptions sold by Doral and Advanced during a period of less than two years, according to the factual basis. 

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 Attorneys Lisa H. Miller and Jon M. Juenger are 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

16-309
Topic: 
Healthcare Fraud
StopFraud
Updated August 10, 2016