Unlicensed Miami Clinic Nurse Convicted at Trial and Sentenced for Role in $11 Million HIV Infusion Fraud Scheme
An unlicensed nurse who fled after being charged in 2008 and was captured this year was sentenced today to serve 108 months in prison for her role in a fraud scheme that resulted in more than $11 million in fraudulent claims to Medicare.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement.
Carmen Gonzalez, 39, of Cape Coral, Fla., worked at St. Jude Rehabilitation Center, a fraudulent HIV infusion clinic in Miami, that was controlled by her cousins, Jose, Carlos and Luis Benitez, aka the Benitez Brothers. Gonzalez was also sentenced for failing to appear at a June 2008 bond hearing. The sentencing follows her conviction at trial to one count of conspiracy to defraud the United States to cause the submission of false claims and to pay health care kickbacks and one count of conspiracy to commit health care fraud. Gonzalez had previously pleaded guilty to a separate charge of failure to appear.
Gonzalez was sentenced by Chief United States District Judge Federico A. Moreno in Miami, who also sentenced her to serve three years of supervised release.
Evidence at trial revealed that Gonzalez was an unlicensed nurse who paid thousands of dollars over a five month period to HIV beneficiaries so that St. Jude could submit millions of dollars in false and fraudulent claims to Medicare. Gonzalez knew that St. Jude billed millions of dollars to Medicare for expensive HIV infusion therapy that was neither medically necessary nor provided. Gonzalez fabricated patient medical records to facilitate and conceal the fraud, and these fabricated records were utilized to support the false and fraudulent claims submitted to Medicare on behalf of St. Jude.
On Oct. 17, 2013, Gonzalez pleaded guilty to knowingly and willfully failing to appear at a June 2008 hearing as directed by Judge Moreno. Court documents reveal that Gonzalez was released on bond pending trial, but she knowingly and willfully failed to appear as directed by the court to a June 2008 hearing.
In January 2013, Gonzalez’s father, Enrique Gonzalez, was sentenced to 70 months in prison by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida for his role in separate health care fraud conspiracy.
The Benitez Brothers remain fugitives. Anyone with information regarding their whereabouts is urged to contact HHS-OIG at 202-619-0088.
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 for the Southern District of Florida. This case was prosecuted by Trial Attorneys Allan Medina and Nathan Dimock 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 more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with 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