Medical Clinic Owners Indicted For Medicare And Medicaid Fraud
ATLANTA – Miguel Angel Hernandez and Maria del Pilar Moreira have been indicted on charges of conspiracy and healthcare fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program.
“These defendants are charged with preying on senior citizens to steal millions of dollars in Medicare and Medicaid funds,” said United States Attorney Sally Quillian Yates. “They are now being held accountable for their outrageous conduct.”
“Health care business owners who try to make a quick buck by billing taxpayer-funded health care programs for services they never actually provided will instead pay a high price for their greed-fueled fraud,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta.
Attorney General Sam Olens said, “The alleged scam by the defendants in this case is reprehensible. We work diligently to protect our Medicaid dollars, and we will not allow our finite funds to be used as a personal piggy bank for dishonest providers. We look forward to working with the U.S. Attorney’s Office in prosecuting this case.”
According to United States Attorney Yates, the charges and other information presented in court: Hernandez and Moreira owned and operated two medical clinics, East Point Medical Center in East Point, Ga., and Family First Medical Center, in Chamblee, Ga. From 2010 to 2013, the defendants allegedly submitted false claims to Medicare and Medicaid for medical services that were never provided to their clinics’ patients.
As part of the alleged scheme, the defendants transported patients in vans daily from locations including senior centers, with up to 60 patients arriving for treatment each day. Physical therapists sometimes led the patients in group exercises, but other times unlicensed aids supervised the patients. Although these patients received little medical treatment, the defendants allegedly submitted bills claiming falsely that each patient had received multiple physical therapy procedures. The defendants billed Medicare and Medicaid over $2 million for various individual physical therapy procedures they claimed to have provided to patients. A Medicare audit revealed that on occasion the defendants billed more than 24 hours’ worth of medical services in a single day.
The defendants also allegedly billed Medicare and Medicaid for numerous trigger point injections that were never given. Although some patients received a limited number of trigger point injections as a treatment for pain, the defendants billed for many more injections than were actually given. The defendants sometimes gave patients Vitamin B-12 injections and then billed them as trigger point injections. This part of the fraud was particularly profitable, because Medicare paid $0.66 for a B-12 shot whereas it paid $58.52 and $60.56 for two kinds of trigger point injections.
The defendants submitted the bills to Medicare and Medicaid under the name of a medical doctor who did not perform the services claimed. The doctor was in the clinic only a couple of days a week and saw a limited number of patients, yet his name appeared as the provider for most of the services billed by the defendants.
The defendants also designed and implemented promotions to attract patients to their clinic. They offered the patients massages, cash, gift cards, food, dollar prizes, and raffles for televisions, to induce the patients to visit the clinic on a regular basis. They also held Bingo games at the clinic and hosted holiday luncheons for the patients.
Three holiday luncheons are described in the indictment. On November 28, 2011, the defendants had patients driven to a Thanksgiving party at Big Daddy’s Dish restaurant in College Park, Ga. On December 30, 2011, patients were driven to a Christmas party at Piccadilly restaurant in Atlanta, Ga. On May 14, 2012, patients were driven to a Mother’s Day party again at Piccadilly restaurant. The defendants submitted bills to Medicare and Medicaid for physical therapy procedures and trigger point injections allegedly provided to the patients on the days of these parties, even though the patients received no medical services there. At the Thanksgiving and Christmas parties, the defendants held raffles and gave away televisions.
A federal grand jury indicted Hernandez, 58, and Moreira, 47, both formerly of Atlanta, Ga. The indictment charges the defendants with one count of conspiracy to commit healthcare fraud and 24 counts of healthcare fraud. The defendants’ whereabouts are currently unknown. Anyone with information about the location of these defendants is asked to contact the U.S. Department of Health and Human Services, Office of Inspector General toll-free at 1-888-476-4453, or submit this form: https://forms.oig.hhs.gov/hotlineforms/fugitive-form.aspx.
Members of the public are reminded that the indictment contains only allegations. The defendants are presumed innocent of the charges and it will be the government’s burden to prove the defendants’ guilt beyond a reasonable doubt at trial.
This case is being investigated by Special Agents of the U.S. Department of Health and Human Services, Office of the Inspector General, and Investigators from the Georgia Medicaid Fraud Control Unit and the Georgia Department of Community Health.
Assistant United States Attorney Stephen H. McClain and Georgia Assistant Attorney General Lyndie M. Freeman are prosecuting the case.
For further information please contact the U.S. Attorney’s Public Information Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.