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Justice News

Department of Justice
U.S. Attorney’s Office
Southern District of Florida

FOR IMMEDIATE RELEASE
Wednesday, June 22, 2016

100 Charged in Southern District of Florida as Part of Largest National Health Care Fraud Takedown in History

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Attorney General Loretta E. Lynch, George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Norbert E. Vint, Acting Inspector General, U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG), Pam Bondi, Florida Attorney General, George M. Karavetsos, Director, U.S. Food and Drug Administration’s (FDA) Office of Criminal Investigations (OCI), John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service (DCIS) Southeast Field Office, Max Eamiguel, Special Agent in Charge, U.S. Postal Service, Office of Inspector General (USPS-OIG), Robert C. Hutchinson, Acting Special Agent in Charge, U.S. Immigration and Customs Enforcement’s Homeland Security Investigations (ICE-HSI), Miami Field Office, Diane J. Sabatino, Director, Field Operations, U.S. Customs and Border Protection (CBP), and Frank Robey, Director, U.S. Army Criminal Investigative Command’s, Major Procurement Fraud Unit, announce that 100 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare and Medicaid out of approximately $220 million.  The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in 36 federal districts that resulted in charges against 301 individuals, including 61 doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings.  In addition, the HHS Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act.  This coordinated takedown is the largest in the history of the Medicare Fraud Strike Force.

The defendants announced today are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy and prescription drugs.  Approximately 28 South Florida defendants are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall. 

U.S. Attorney Wifredo A. Ferrer stated, “The United States Attorney’s Office for the Southern District of Florida remains relentless in combating health care fraud. The takedown announced today is the largest in the history of the Southern District of Florida in terms of the number of defendants charged. It also demonstrates that we continue to prosecute every link in the health care fraud chain - from the pharmacy or home health agency owner that submits false claims to the Medicare beneficiaries who decide to abuse their health care privileges by accepting kickbacks from patient recruiters, to the medical professionals whose judgment becomes compromised by the payment and receipt of kickbacks, we will find them and bring them to justice. I thank our federal, state and local law enforcement partners who with our Office stand committed to find, stop and punish those who steal from a program that provides the security of health care to the most needy in our society.”

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Lynch.  “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.  The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $900 million in fraudulent billing.

“Health care providers and patients are key to protecting the Medicare and Medicaid programs, but when they instead choose to commit fraud and engage in widespread kickback schemes, they steal precious tax dollars and corrupt the integrity of our health care system,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health & Human Services Office of Inspector General (OIG).  “This takedown reflects the dedication of OIG and our law enforcement partners to bring such fraudsters to justice.”

Acting Inspector General Norbert E. Vint stated, “Today’s arrests demonstrate that the U.S. Government will not tolerate fraud in the compounding pharmacy industry.  We appreciate the efforts of all the investigating agencies and the Department of Justice that have held these individuals accountable for their actions, and thereby protected taxpayer funded health care programs, including the Federal Employees Health Benefits Program.”  

Florida Attorney General Pam Bondi stated, “With this historic fraud takedown we are sending the message to anyone scheming to steal from our Medicaid and Medicare programs that we will find them and they will be held accountable.  Thanks to the joint efforts of my Medicaid Fraud Control Unit and our federal partners, this takedown has stopped millions of dollars in potential future fraud and will ensure those responsible are held to account.”

“Healthcare providers who dispense prescription drugs that are medically unnecessary put patients’ health at risk,” said George M. Karavetsos, Director, FDA Office of Criminal Investigations. “The FDA will continue to pursue those who perpetrate fraudulent schemes that target the health and safety of consumers.”

“These arrests demonstrate an unrelenting effort by the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of the Department of Defense (DoD) health care program,” said Special Agent in Charge John F. Khin, Southeast Field Office. “Fraud and abuse by pharmacies, marketing entities, and medical providers involved in fraudulent compounded drug prescriptions is a significant threat to the DoD health care system. DCIS will fully pursue both criminal and civil remedies to recover taxpayer dollars and bring justice to violators who target American service members, veterans, and their families.”

“These arrests should send a clear message to all pharmacies that FEHB fraud is a federal crime that carries serious consequences and will not be tolerated,” said Special Agent in Charge Max Eamiguel, U.S. Postal Service, Office of Inspector General (USPS-OIG.) “We along with our law enforcement partners will continue to aggressively investigate those who engage in fraudulent activities intended to defraud federal benefit programs and the Postal Service.”

“We utilize our extensive financial and money laundering investigative authorities to combat fraud throughout our economy, especially in areas such as identity theft and health care fraud,” said Robert C. Hutchinson, Acting Special Agent in Charge of HSI Miami.  “Due to the importance of the health care sector, these investigations are particularly critical for our nation.”

“U.S. Customs and Border Protection is committed to fighting fraud by providing unparalleled support to an ever-expanding network of law enforcement partners across Florida,” said Diane J. Sabatino, Director Field Operations for Miami/Tampa Field Offices. “CBP enforces more than 400 laws and regulations for 40 different agencies and will continue to work alongside local, state, and federal government partners every day to protect the public.”

“We are very pleased with the results of this complex and lengthy investigation and today’s announcement is a textbook example of seamless interagency law enforcement cooperation and teamwork,” said Frank Robey, Director of the U.S. Army Criminal Investigation Command’s Major Procurement Fraud Unit.  “Our agency stands ready and able to fully investigate allegations of this nature that impact DOD and the American taxpayers.”

In the Southern District of Florida, a total of 100 defendants were charged with offenses relating to their participation in various fraud schemes involving approximately $220 million in false billings for home health care, mental health services and pharmacy fraud.  Below are some of the cases included in the takedown:

A. MEDICARE PART D

1.  United States v. Edgardo Lobo, et al., Case No. 16-20334-CR-Lenard

Edgardo Lobo, 50, of Miami, the owner or operator of Oshun Pharmacy, Lycan Services, Accalia Crative and Formula Pharmaceuticals; Ileana Calvo, 51, of Miami, the president of Universal Healthcare; and Juan Carlos Acosta, 53, of Hialeah, president of Pharmmed Delivery, were charged with one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive health care kickbacks, and one count conspiracy to commit money laundering.  Additionally, Edgardo Lobo was charged with five counts of health care fraud, and seven counts of money laundering; Ileana Calvo was charged with two counts of money laundering; and Juan Carlos Acosta was charged with three counts of money laundering.  The charges stem from the defendants’ role in a $4.8 million pharmacy fraud scheme. 

Mr. Ferrer commended the investigative efforts of FBI and HHS-OIG.  This case is being prosecuted by DOJ Attorney Lisa Miller of the Criminal Division’s Fraud Section.

 

2.  United States v. Nereida Montejo, et al, Case No. 16-20400-CR-Scola

Nereida Montejo, 65, of Miami, owner and operator, Nerta Rodriguez, 73, of Miami, operator, and Carlos Hernandez, 64, of Miami, patient recruiter, all for New Pharmacy Discount, Corp., were charged with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks.  Montejo and Rodriguez were additionally charged with one count of conspiracy to commit health care fraud and wire fraud.  Montejo was also charged with nine counts of health care fraud, and four counts of payment of kickbacks in connection with a federal health care program.  The charges stem from each defendants’ alleged role in a $5.2 million scheme, whereby Montejo, as the owner and operator of New Pharmacy, paid kickbacks and bribes to patients and patient recruiters in order to bill both Medicare and Medicaid for medications that were not purchased.  

Mr. Ferrer commended the investigative efforts of the FBI, HHS-OIG and the State of Florida Medicaid Fraud Control Unit. This case is being prosecuted by DOJ Attorney Stephen Cincotta of the Criminal Division’s Fraud Section.

 

3.  United States v. Arturo Rodriguez Sr, Case No. 16-20425-CR-Lenard

Arturo Rodriguez, 69, of Miami, owner and operator of Olympia Discount, Corp. was charged with conspiracy to commit health care fraud and wire fraud, and conspiracy to defraud the United States and pay health care kickbacks.  The charges stem from Rodriguez’s alleged role in a $2.6 million scheme, whereby Rodriguez, as the owner and operator of the Olympia Discount pharmacy, paid kickbacks and bribes to patients and patient recruiters in order to bill Medicare for medications that were not prescribed to patients, were not necessary, and were not purchased.  

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Stephen Cincotta of the Criminal Division’s Fraud Section.   

 

4.  United States v. Andy Armas, Case No. 16-20474-CR-Middlebrooks

Andy Armas, 34, of Miami, owner and operator of Millenium Pharmacy and Marlins Pharmacy, was charged with one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud, and one count of conspiracy to defraud the United States and pay health care kickbacks.  The charges stem from Armas’s role in a $5.7 million scheme, whereby Armas, as the owner and operator of Millenium and Marlins pharmacies paid kickbacks and bribes to patients and patient recruiters in order to bill Medicare for medications that were not purchased. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Stephen Cincotta of the Criminal Division’s Fraud Section.   

 

5.  United States v. Niurka Fernandez and Roberto Alvarez, Case No. 16-20391-CR-Moreno

Niurka Fernandez, 54, of Miami, and Roberto Alvarez, 29, of Sweetwater, were charged with allegations that they participated in a health care fraud conspiracy involving two pharmacies, Calan Pharmacy and Best Pharmacy, both located in Miami.  According to the indictment, the scheme involved paying kickbacks to patient recruiters and Medicare beneficiaries, as well as billing Medicare for prescription drugs that were never in fact dispensed.  Both defendants were charged with conspiracy to commit health care fraud and wire fraud; conspiracy to commit money laundering; and substantive counts of money laundering.  Additionally, Fernandez was charged with five substantive counts of health care fraud.  In total, the indictment alleges a loss of over $16 million. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney L. Rush Atkinson of the Criminal Division’s Fraud Section.   

 

6.  United States v. Reinaldo Morey, et al., Case No. 16-20460-CR-Cooke

Reinaldo Morey, 50, and Niurka De La Caridad Morey, 50, both of Miami, were charged with conspiracy to commit health care fraud and health care fraud for using their pharmacy, Dalice Medical Equipment to bill Medicare for prescriptions that were never dispensed to the patients.  The loss to Medicare was over $3.4 million.                

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Elizabeth Young of the Criminal Division’s Fraud Section

 

7. United States v. Carlos Cardenas, Case No. 16-20480-CR-Gayles

Carlos Cardenas, 47, of Miami, a pharmacy owner, was charged with health care fraud.  The charges stem from Cardenas using his pharmacy, Nuestra Pharmacy, to bill Medicare for $730,000 in prescriptions that were never dispensed.               

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Elizabeth Young of the Criminal Division’s Fraud Section.  

 

8.  United States v. Marlenis Fernandez, Case No. 16-20486-CR-Moore

Marlenis Fernandez, 51, of Miami, owner of United Care Pharmacy, was charged with conspiracy to commit health care fraud.  The charges stem from Fernandez’s alleged role in a scheme to defraud Part D of the Medicare program by billing for more than $900,000 of prescription drugs that were never purchased, never provided and were not medically necessary.  As a result of the scheme, Medicare paid over $900,000 in fraudulent claims. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Timothy P. Loper of the Criminal Division’s Fraud Section.   

9.  United States v. Gabriela Alegria, Case No. 16-20485-CR-Lenard

Gabriela Alegria, 43, of Miami, owner of GAC Investor Corporation, was charged with conspiracy to commit money laundering.  The charges stem from Alegria’s alleged involvement in a scheme in which the defendant established and maintained signature authority on business accounts that she used to launder over $700,000 in proceeds from a Medicare fraud scheme.            

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Timothy P. Loper of the Criminal Division’s Fraud Section.   

 

10.  United States v. Anet Martinez Gonzalez, Case No. 16-20450-CR-Scola

Anet Martinez Gonzalez, 43, of Dania, was charged with conspiracy to commit health care fraud and wire fraud.  The Information alleges that Gonzalez was the manager of Calle Ocho Pharmacy in Miami.  The Information further alleges that Gonzalez submitted and caused the submission of false and fraudulent claims to Medicare and Medicare drug plan sponsors for prescription drugs that were not actually provided to Medicare beneficiaries.  As a result of these false and fraudulent claims, Medicare drug plan sponsors made payments funded by Medicare in the approximate amount of $273,757.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

11.  United States v. Jose Nunez, Case No. 16-20458-CR-Scola

Jose Nunez, 64, of Miami, was charged with conspiracy to commit money laundering, money laundering, and witness tampering.  The Indictment alleges that Nunez laundered approximately $196,500 in health care proceeds drawn from corporate accounts belonging to La Esperanza Pharmacy Discount, Inc.  The Indictment further alleges that Nunez knowingly attempted to and engaged in witness tampering by directing an individual to falsely state that the monies provided to him were a loan for the purchase of certain real estate, with the intent to hinder and prevent the communication to federal agents of the United States Department of Health and Human Services, Office of Inspector General, and the FBI, rather than illegal proceeds from health care fraud. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

 

12.  United States v. Roslane Pichs, et al., Case No. 16-20479-CR-Ungaro         

Roslane Pichs, 41, Daniel Pichs Gonzalez, 64, and Raquel Castro, 63, all of Miami, were charged with conspiracy to commit health care fraud and wire fraud.   Pichs and Gonzalez were also charged with six counts of substantive health care fraud.  The Indictment alleges that Pichs, Gonzalez, and Castro submitted and caused the submission of fraudulent claims, via interstate wire, that falsely represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided to Medicare beneficiaries by the defendants’ businesses, Mazal Tov Pharmacy, Inc. and Angel’s Light Pharmacy & Discount.  As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts controlled by the three defendants in the approximate amount of $7,709,636.

Mr. Ferrer commended the investigation efforts of HHS-OIG and ICE-HSI.  This case is being prosecuted by Assistant U.S. Attorney Roger Cruz.

 

13.  United States v. Alexis Avila, et al., Case No. 16-20471-CR-Altonaga

              

Alexis Avila, 39, Raiza Ruiz, 43, and Yis Fernandez, 36, all of Hialeah, were charged with conspiracy to commit health care fraud.  The Information alleges that Avila, Ruiz, and Fernandez submitted and caused the submission of claims, via interstate wire, which falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by La Esperanza Pharmacy Discount, Inc., in Hialeah, to Medicare beneficiaries.  La Esperanza was purportedly a pharmacy that provided Medicare beneficiaries with various pharmaceutical items and services. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors, made payments funded by the Medicare Part D Program to the corporate bank accounts of La Esperanza in the approximate amount of $6,747,469.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher Clark.

 

14.  United States v. Dora Josefa Robaina, Case No. 16-20490-CR-Bloom

Dora Josefa Robaina, 48, of North Bay Village, was charged with failure to appear, in violation of Title 18, United States Code, Section 3146.  In the case of United States v. Dora Josefa Robaina, Case No. 15-20799-CR-Middlebrooks, the defendant was previously sentenced to thirty three months in prison after she pled guilty to accessory after the fact in connection with her role in deceiving federal agents who attempted to arrest Antonio Hevia and Pedro Torres, two defendants who were involved in the submission of $16.7 in false claims to Medicare.  At the sentencing hearing, Robaina was ordered to surrender to the Bureau of Prisons on June 10, 2016 and she failed to do so.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG.  This case is being handled by Assistant U.S. Attorney James Hayes.

 

B.  HOME HEALTH

 

15.  United States v. Daylin Cabrera, et al, Case No. 16-20476-CR-Zloch

Daylin Cabrera, 33, the owner of a fraudulent physical therapy staffing company; Raciel Leon, 42, the office manager of a fraudulent home health care company; and Alex Lopez Huergo, 37, all of Miami, the owner of a fraudulent home health care company were charged with conspiracy to commit health care fraud and one count of conspiracy to pay and receive kickbacks.  Additionally, Cabrera was charged with two counts of health care fraud.  The charges stem from their role in a $2.5 million home health care fraud scheme. 

Mr. Ferrer commended the investigative efforts of FBI and HHS-OIG. This case is being prosecuted DOJ Attorneys Lisa Miller and Elizabeth Young of the Criminal Division’s Fraud Section.

 

16.  United States v. Jose Avila, M.D. and Michael Bahrami, M.D., Case No. 16-20471-CR-Altonaga

Jose Avila, 58, of Hallandale, and Michael Bahrami, 60, of Golden Beach, two medical doctors, were charged with conspiracy to defraud the United States and receive health care kickbacks.  Avila was also charged with one count of receiving health care kickbacks.  The charges stem from their involvement in a $57 million home health fraud scheme involving paying kickbacks to doctors and patient recruiters, and billing for services that were not necessary and/or not provided.  Avila was previously charged by Complaint with receiving kickbacks in connection with a federal health care program.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Vasanth Sridharan of the Criminal Division’s Fraud Section.   

 

17.  United States v. Cynthia Vilches, Case No. 16-20466-CR-Moore

Cynthia Vilches, 47, of Miramar, owner of Healthy Choice Home Health, was charged with one count of conspiracy to commit health care fraud.  The charge arises from Vilches’ role in a $56 million home health fraud scheme involving paying kickbacks to doctors and patient recruiters, and billing for services that were not necessary and/or not provided. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Vasanth Sridharan of the Criminal Division’s Fraud Section.  

 

18.  United States v. Reidy Gonzalez, et al., Case No. 16-20464-CR-Zloch

Reidy Gonzalez, 43, and Yelina Isabel Gonzalez, 44, both of Miami, were charged with one count of conspiracy to defraud the United States and pay health care kickbacks.  The charges stem from allegations that both defendants, who owned and controlled Dade-Kendall Home Healthcare Services, Inc., a home health agency in Miami, paid kickbacks to a patient recruiter in exchange for patients and billed Medicare for those patients. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney L. Rush Atkinson of the Criminal Division’s Fraud Section.   

 

19.  United States v. Mildrey Gonzalez, et al., Case No. 16-20461-CR-Martinez

Mildrey De La Caridad Gonzalez, 61, of Miami Beach, Milka Yarlin Alfaro, 39, of Miami Beach, Adriana Damas Jalil, 38, of Miami, and Luis Enrique Luzardo, 47, of Miami, were indicted on charges stemming from their respective roles in a scheme to defraud Medicare resulting in losses over $24 million.  The alleged scheme involved six home health agencies in the greater Miami area, all of which are alleged in the Indictment to have been owned and controlled by Gonzalez and Alfaro.  Gonzalez and Alfaro were charged with one count of conspiracy to commit health care fraud and wire fraud; seven counts of health care fraud; conspiracy to defraud the United States and pay and receive kickbacks in connection with a federal health care benefit program; conspiracy to commit money laundering, and substantive counts of money laundering.  Jalil was charged with one count of conspiracy to defraud the United States and pay and receive kickbacks in connection with a federal health care benefit program and three substantive counts of receiving kickbacks in in connection with a federal health care benefit program.  Luzardo was charged with one count of conspiracy to commit money laundering and two substantive counts of money laundering. 

          Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney L. Rush Atkinson of the Criminal Division’s Fraud Section.   

 

20.  United States v. Noemi Rodriguez, Case No. 16-20413-CR-Moreno

Noemi Rodriguez, 52, of Hialeah, President and Operator of US Care Network, Inc., was charged with conspiracy to defraud the United States and to solicit and receive kickbacks and four counts of soliciting and receiving kickbacks.  The charges arise from Rodriguez’s alleged involvement in recruiting patients and providing prescriptions for home health agencies in exchange for kickbacks.  

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Katherine Payerle of the Criminal Division’s Fraud Section.   
 

 

21.  United States v. Armando Salazar, Case No. 16-20379-CR-Moreno

Armando Salazar, 65, of Miami, President and Director of Monzon Medical Diagnostic Corp., was charged with conspiracy to defraud the United States and receive health care kickbacks, receiving kickbacks in connection with a federal health care program, and three counts of health care fraud.  The charges arise from Salazar’s alleged role in a $1.4 million scheme involving kickback payments for home health prescriptions. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Katherine Payerle of the Criminal Division’s Fraud Section.    

 

22.  United States v. Joanna Carpio and Leonie Dorce,             Case No. 16-20412-CR-Gayles

Joanna Carpio, 25, of Miami, clinic office manager, and Leonie Dorce, 71, of Miami Lakes, Advanced Registered Nurse Practitioner, at City Center Rehab Corp., were charged with conspiracy to commit health care fraud.  Carpio was also charged with conspiracy to defraud the United States and receive health care kickbacks.  The charges arise from Carpio and Dorce’s alleged role in a more than $36 million scheme involving payment of kickbacks for prescriptions and referrals for home health care and other medical services.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Katherine Payerle of the Criminal Division’s Fraud Section. 

 

23.  United States v. Francisco Correa Delgado, Case No. 16-20482-CR-Moreno

 

Francisco Correa Delgado, 46, of Hialeah, President and Director of the home health agency, H&E Home Care, Inc., was charged with four counts of health care fraud for his role in a $3.1 million scheme.  The charges arise from Delgado’s ownership of a home health agency that billed Medicare for home health services that were never prescribed by a licensed physician or provided to Medicare beneficiaries. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Katherine Payerle of the Criminal Division’s Fraud Section.  

 

24.  United States v. Dagoberto Morales, Case No. 16-20414-CR-Altonaga

Dagoberto Morales, 36, of Hialeah, President and Director of the home health agency, Samy Nursing Corp., Inc., was charged with four counts of health care fraud for his role in a $6 million scheme.  The charges arise from Morales’ ownership of a home health agency that allegedly billed Medicare for home health services that were never prescribed by a licensed physician or provided to Medicare beneficiaries.      

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Angela Adams of the Criminal Division’s Fraud Section.  

 

25.  United States v. Dayami Martinez and Yadira Robertson, Case No. 16-20431-CR-Cooke 

Dayami Martinez, 41, of Miami, Director of Nursing for two home health agencies, and Yadira Robertson, 55, of Miramar, physical therapy assistant working for a therapy staffing company, were charged with conspiracy to commit health care fraud and wire fraud.  Martinez was also charged with two counts of false statements in connection with a federal health care program, and Robertson was charged with 10 counts of that crime.  The charges arise from their involvement in an $830,000 fraud scheme between the therapy staffing company, R.C. Therapy, and two home health agencies, Maya Home Health and Floridian Home Health.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Vasanth Sridharan of the Criminal Division’s Fraud Section.   

 

26.  United States v. Elvis Hernandez, Case No. 16-20415-CR-Moore

Elvis Hernandez, 43, of Hialeah, President and Director of the home health agency, Global Nursing Association, Inc., was charged with three counts of health care fraud for his role in a $3.5 million scheme.  The charges arise from Hernandez’s ownership of a home health agency that allegedly billed Medicare for home health services that were never prescribed by a licensed physician or provided to Medicare beneficiaries. 

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Angela Adams of the Criminal Division’s Fraud Section.   

 

27.  United States v. Pavel Aguila, et al., Case No. 16-20478-CR-Williams

Pavel Aguila, 42, of Miami, Laura Perez, 48, of Miami, and Emilio Enriquez, 53, of Florida City, were charged with conspiracy to defraud the United States and substantive counts of receiving kickbacks in connection with a federal health care program.  The indictment alleges that Aguila, Perez, and Enriquez were patient recruiters who accepted kickbacks in return for referring Medicare beneficiaries to Casper Home Health, a Miami-Dade based home health agency

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Kevin Larsen.

 

28.  United States v. Carlos F. Valencia, et al., Case No. 16-20462-CR-Moreno

Carlos F. Valencia, 45, of Miami Lakes, Rosa M. Cabrera, 58, of Hialeah, Reynaldo Cubilla, 64, of Miami, Josefina Caridad Fornells, 77, of Miami, Epifania Gonzalez, 76, of Miami, Francisco Emilio Hernandez, 83, of Miami, Evelio Linares, 82, of Miami, Zoila Miranda, 59, of Miami, Jacinto Margarito Montenegro, 84, of Miami, Francisco Oramas, 82, of Miami, and Electo Pena, 65, of Miami, were charged with conspiracy to pay and receive health care kickbacks and substantive counts of paying and receiving kickbacks.  The Indictment alleges that Valencia was the owner of D’Val home health agency, a company that purportedly provided skilled nursing services to homebound Medicare beneficiaries. The Indictment alleges that Valencia paid kickbacks to patient recruiters who referred Medicare beneficiaries.  The Indictment further alleges that Medicare beneficiaries Hernandez, Linares, Miranda, Montenegro, Oramas, and Pena accepted kickbacks in return for agreeing to serve as patients for the home health agency.  The indictment alleges that these kickbacks ranged in amounts from $760 to $1,200.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Michael Nadler.

 

29.  United States v. Sulman Bonilla, Case No. 16-20401-CR-Dimitrouleas        

Sulman Bonilla, 46, of Miami, was charged with conspiracy to defraud the United States and pay health care kickbacks, and substantive counts of paying health care kickbacks.  The Indictment alleges that Bonilla paid kickbacks to patient recruiters in exchange for the referral of Medicare beneficiaries to American Way Home Care, a Miami-Dade home health care agency.  The Indictment further alleges that Bonilla caused American Way Home Care to submit claims to Medicare for services purportedly provided to the recruited beneficiaries.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Amanda Perwin.

 

30.  United States v. Erika Bonilla, et al., Case No. 16-20402-CR-Lenard              

Erika Bonilla, 41, and Emmanuel Ventura, 48, both of Miami, were charged with conspiracy to defraud the United States and pay health care kickbacks, and substantive counts of paying health care kickbacks.  The Indictment alleges that Bonilla and Ventura paid kickbacks to patient recruiters in exchange for the referral of Medicare beneficiaries to America Home Health, a Miami-Dade home health care agency.  The Indictment further alleges that Bonilla and Ventura caused America Home Health to submit claims to Medicare for services purportedly provided to the recruited beneficiaries.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Amanda Perwin.

 

C.  COMMUNITY MENTAL HEALTH

31.  United States v. Caridad Turner, Case No. 16-20443-CR-Altonaga

Caridad Turner, 43, of Miami, a clinical director of a now defunct partial hospitalization program a Greater Miami Behavioral Health, was charged with conspiracy to commit healthcare fraud.  The charges stem from the defendant’s role in a $60 million scheme to defraud the federal Medicare program.            

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Elizabeth Young of the Criminal Division’s Fraud Section.   

 

32.  United States v. Felix Lamelas, et al., Case No. 16-20453-CR-Zloch

Felix Lamelas, 60, of Miami, Dunia Ayala, 50, of Miami, Jose Ortiz, 58, of Hialeah, Hildara Urquiola, 77, of Pembroke Pines, and Marta Maggi, 80, of Pembroke Pines, were charged for their role in recruiting patients for the now defunct partial Hospitalization program at Greater Miami Behavioral Health.   All defendants were charged with conspiracy to pay and receive kickbacks in connection with a federal health care benefit program for their roles in a $60 million fraud scheme.           

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Attorney Elizabeth Young of the Criminal Division’s Fraud Section.   

 

D.  MEDICARE PART C (MEDICARE ADVANTAGE)

 

33.  United States v. Ruth Aracelly Garcia, Case No. 16-20483-CR-Altonaga

                

Ruth Aracelly Garcia, 37, of Miami, a former office manager of Santiago Montoya, M.D., was charged with conspiracy to commit health care fraud, health care fraud, conspiracy to defraud the United States, and making false statements related to a health care matter.  The Indictment alleges that Garcia and her co-conspirators recruited Medicare beneficiaries residing in Nicaragua to enroll in Medicare Advantage plans, submitted plan enrollment requests on behalf of Medicare beneficiaries that falsely and fraudulently represented that the beneficiaries resided in the plans service area within Florida, and enrolled Medicare beneficiaries residing in Nicaragua into Florida Medicaid by falsely and fraudulently representing that the beneficiaries resided in the United States.

Mr. Ferrer commended the investigative efforts of the FBI, HHS-OIG and the State of Florida Medicaid Fraud Control Unit. This case is being prosecuted by Special Assistant U.S. Attorney Hagerenesh Simmons from the Florida Attorney General Office, Medicaid Fraud Control Unit.

 

E.  PRIVATE INSURANCE

 

34.  United States v. Rogelio Alonso, et al., Case No. 16-20457-CR-Williams

                

Rogelio Alonso, 49, Mercedes Alonso, 48, and Sheneider Telfort, 32, all of Miami, were charged with conspiracy to commit health care fraud and substantive counts of health care fraud. The Indictment alleges that Rogelio Alonso, Mercedes Alonso, Sheneider Telfort, and their co-conspirators submitted and caused the submission of false and fraudulent claims to private insurance plans, via interstate wire transmission, including Blue Cross Blue Shield (“BCBS”), Cigna, AvMed, and United Health Care (“UHC”), on behalf of various medical clinics seeking approximately $10,662,813 as reimbursement for injection treatments, physical therapy treatments, and other medical items and services which were neither ordered by a physician nor provided to a beneficiary as claimed.  As a result of such false and fraudulent claims, Rogelio Alonso, Mercedes Alonso, Sheneider Telfort, and their co-conspirators caused private insurance plans, including BCBS, Cigna, and UHC, to make payments to the medical clinics totaling approximately $2,253,322.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant United States Attorney Christopher Clark.  

 

F.  TRICARE

35.  United States v. Celep Simsir, et al., Case No. 16-20399-CR-Gayles

Celep Simsir, 35, and Sonsoles Simsir 39, both of Jacksonville, were charged with conspiracy to commit health care fraud and mail fraud, conspiracy to pay and receive health care kickbacks, substantive counts of health care fraud and the payment and receipt of kickbacks, in connection with a conspiracy to defraud TRICARE, a United States Department of Defense health insurance programs for military personnel and their dependents. Nigal Mitchell, 25, of Jacksonville, and Andrea Rivera-Lorenzo 28, of Puerto Rico, were charged with for receiving kickbacks in return for recruiting TRICARE beneficiaries to participate in the fraudulent scheme.           

The Indictment alleges that Celep Simsir and Sonsoles Simsir paid health care kickbacks to a doctor and a physician’s assistant in the Southern District of Florida in return for prescriptions for compounded medications which were not medically necessary. These medical professionals never examined or spoke with the patients.  These prescriptions were then filled at a pharmacy in the Southern District of Florida which submitted approximately $25,763,938 in false and fraudulent claims.  As a result of these claims, TRICARE made payments of $21,293,201 to the pharmacy. 

According to detention hearing testimony, during the course of affecting the arrest of Celep Simsir and Sonsoles Simsir, federal agents allegedly seized approximately $344,000 in cash, seven firearms, including an AR-15 rifle, a Lamborghini and a Porsche.  Agents also executed seizure warrants that resulted in the seizure of over $2 million.

Mr. Ferrer commended the investigative efforts of DCIS, USPIS-OIG, FDA-OCI, OPM-OIG and U.S. Army Criminal Investigative Command's, Major Procurement Fraud Unit.  This case is being prosecuted by Assistant U.S. Attorneys Daniel Bernstein and Evelyn B. Sheehan. 

 

If convicted of a charged offense, a defendant faces a possible maximum statutory sentence of five years in prison for conspiracy to defraud the United States by paying and receiving health care kickbacks, in violation of Title 18, United States Code, Section 371; five years in prison for payment and receipt of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a; twenty years in prison for mail or wire fraud, in violation of Title 18, United States Code, Section 1341; ten years in prison for health care fraud, in violation of Title 18, United States Code, Section 1347; twenty years for conspiracy to commit health care fraud and wire fraud, in violation of Title 18, United States Code, Section 1349; and twenty years for money laundering or conspiracy to commit money laundering, in violation of Title 18, United States Code, Section 1956.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in nine locations and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion. 

A complaint, information or indictment is merely a charge, and defendants are presumed innocent until proven guilty.

To learn more about HEAT, go to: www.stopmedicarefraud.gov.

 

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov

 

 

 

 

 

 

 

 

 

 

Topic: 
Healthcare Fraud
Updated June 23, 2016