South Florida Doctor And Other Professionals Charged With Health Care Fraud At Biscayne Milieu Health Center, Inc.
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Derrick Jackson, Acting Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General’s (HHS-OIG), Miami Regional Office, announce that Salo Shapiro, 69, a medical doctor, of Broward County, Marlene Cesar, 63, a licensed nurse practitioner, of Allentown, Pennsylvania and former resident of Miami, and Sonia Gallimore, 73, a licensed mental health counselor, of Broward County, were indicted on charges of conspiracy to commit health care fraud, health care fraud, and false statements related to health care matters, in violation of Title 18, United States Code, Sections 1349, 1347, and 1035.
According to the indictment, the defendants and their co-conspirators caused the submission of over $55 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, a Miami-based clinic which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness. Instead, the defendants and their co-conspirators devised a scheme in which ineligible Medicare beneficiaries were admitted to Biscayne Milieu and Medicare was fraudulently billed for services that were never provided. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.
The indictment alleges that, as an attending physician at Biscayne Milieu, Shapiro authorized the treatment of patients that he knew were ineligible for PHP treatment. The same was true of Cesar, who also knowingly admitted ineligible patients as a nurse practitioner. The indictment further alleges that Gallimore, a licensed mental health counselor, conducted sham therapy sessions for patients that she knew were ineligible for PHP treatment. As a result of the defendants’ and their co-conspirators’ actions, Biscayne Milieu billed Medicare for over $55 million in false and fraudulent claims, and Medicare paid the clinic over $11 million.
Various owners, a doctor, managers, therapists, patient brokers and other employees of Biscayne Milieu have also been charged with various health care fraud, kickback, money laundering and other offenses in three other indictments unsealed in September 2011, May 2012, and February 2013. Biscayne Milieu, its owners, and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial. Antonio and Jorge Macli and Sandra Huarte – the owners and operators of Biscayne Milieu – were each convicted at trial of various offenses and were sentenced in April 2013 to 30 years, 25 years, and 22 years in prison, respectively. Dr. Gary Kushner, another attending physician and former medical director of Biscayne Milieu, was sentenced to 12 years in prison in March 2013.
The case is being prosecuted by Assistant U.S. Attorney James V. Hayes of the U.S. Attorney’s Office for the Southern District of Florida; James V. Hayes was formerly a Trial Attorney with the Fraud Section of the Justice Department’s Criminal Division. The case was investigated by the FBI with the assistance of HHS-OIG, and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with the Medicare Fraud Strike Force, supervised by 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 nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 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.
An indictment is merely an accusation, and defendants are presumed innocent unless and until proven guilty.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.