Milwaukee Man Sentenced to Federal Prison for Conspiracy to Defraud Medicare and Medicaid.
Gregory J. Haanstad, United States Attorney for the Eastern District of Wisconsin, announced that on November 18, 2022, David Guerrero, Jr., was sentenced to 32 months’ imprisonment for conspiracy to defraud Medicare and Medicaid. Guerrero was also ordered to pay over $1 million in restitution to Medicare and Medicaid.
Court records in the case established the following. Guerrero worked at two Milwaukee-area medical clinics. Beginning in 2016, Guerrero engaged in a years’ long scheme to refer patients to pharmacies owned by his co-defendant, Alexander Shister, for expensive compound pain creams in exchange for illegal kickback payments. Although he is not a licensed medical provider, Guerrero used his access to private medical records at the clinics to identify patients who could plausibly need the pain creams and then ordered the pain creams from Shister’s pharmacies without the patients’ knowledge or consent. As a result of the scheme, Medicare and Medicaid paid Shister’s pharmacies about $1 million for medically unnecessary pain creams, including creams not even received by patients. Guerrero received over $100,000 in kickbacks from Shister for his role in the scheme. In addition, Guerrero engaged in another kickback scheme with a medical laboratory company, receiving over $150,000 in kickbacks in exchange for ordering urine drug tests that doctors at the clinics generally did not approve or review. In August 2022, Guerrero pleaded guilty to one count of conspiracy. Shister has previously plead guilty for his role. His sentencing is set for January 13, 2023.
At sentencing, United States District Judge J.P. Stadtmueller emphasized the seriousness of Guerrero’s crime, including the length of the fraudulent scheme and the significant losses suffered by the Medicare and Medicaid programs. Judge Stadtmueller further noted that Guerrero violated the trust of patients by using their private medical information without their knowledge or consent in order to implement the scheme and earn his kickback payments.
“Medicare and Medicaid only pay for medications and services that are actually needed to treat patients, not items ordered by individuals working in the medical field to line their own pockets,” said United States Attorney Haanstad. “Guerrero took advantage of his access to patients’ private medical information to order millions of dollars of unnecessary pain creams and drug tests, all so that he could earn hundreds of thousands of dollars of illegal kickbacks. This office is committed to working with our federal, state, and local partners to prevent kickback schemes and other frauds against the Medicare and Medicaid programs.”
“The billing of medically unnecessary medications and tests, as well as the payment of kickbacks to induce those referrals to a federal health care program is illegal,” said Mario M. Pinto, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General. “The OIG is committed to working with our law enforcement partners to hold those who seek to defraud federally funded health care programs accountable.”
"The defendant thought he could get away with criminal activity, accessing patient’s medical records without their knowledge and using that information for personal financial gain,” said FBI Special Agent in Charge Michael E. Hensle. “Working with his co-defendant, they conspired to receive significant payments of nearly $1 million from Medicare and Medicaid for unnecessary medical products. They also received over $150,000 in kickbacks from a medical lab. The FBI continues to stand with our local, state, and federal partners to identify, investigate, and bring these offenders to face justice.”
The Federal Bureau of Investigation and the Office of the Inspector General for the Department of Health and Human Services investigated the case. Assistant United States Attorneys Benjamin Proctor and Michael Carter handled the prosecution.
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