Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Michael B. Steinbach, Acting Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), and Tony Gomez, Acting Inspector in Charge, U.S. Postal Inspection Service, Miami Division, announced that thirty-three (33) South Florida residents were charged for their alleged participation in various schemes to defraud Medicare out of more than $202 million. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that resulted in charges against 91 individuals, including doctors, nurses and other licensed professionals, for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing.
In this national operation, dozens of charged individuals were arrested or surrendered in the last 24 hours as indictments were unsealed across the country. Together, those indictments charge more than $230 million in home health care fraud; more than $100 million in community mental health care fraud and more than $49 million in ambulance transportation fraud.
The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. More than 500 law enforcement agents from the FBI, HHS-OIG, U.S. Postal Inspection Service, and other state and local law enforcement agencies participated in the national takedown.
U.S. Attorney Wifredo A. Ferrer stated, “Holding accountable those who abuse Medicare for personal profit is one of my top priorities. Those individuals who steal from Medicare are not just stealing from the government. Instead, they are stealing from the most vulnerable among us – the sick, the elderly and the poor. We will not relent in our efforts to prosecute these fraudsters, bring them to justice, and seize their illegal income and assets for ultimate return to the Medicare program.”
“Over one third of those charged today in this multi-city health care fraud takedown were from the Miami area, accounting for more than $202 million in fraud,” said Michael B. Steinbach, Acting Special Agent in Charge of FBI Miami Division. “The FBI and its partners devote vast resources to investigate, catch and prosecute those committing health care fraud. To attack the problem from both ends, tougher regulation and oversight are key to reducing the amount of fraud from occurring in the first place.”
“Here in South Florida we must remain vigilant to address healthcare fraud in its many evolving forms,” said Christopher B. Dennis, Special Agent in Charge of the U.S. Department of Health and Human Services’ Office of Inspector General Miami region. “When hospitals, home health agencies, pharmacies, or other healthcare providers are suspected of breaking the law, they should expect swift justice.”
Tony Gomez, Acting Inspector in Charge for the U.S. Postal Inspection Service stated, “The U.S. Postal Inspection Service will continue to partner with the U.S. Attorney’s Office and the law enforcement community to ensure that the U.S. mail is not a conduit for this kind of fraudulent activity.”
The South Florida defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, and physical and occupational therapy. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.
Specifically, the South Florida cases announced as part of the nationwide Medicare Fraud Strike Force takedown include:
U.S. v. Karen Kallen-Zury, Daisy Miller, Christian Coloma, Michele Petrie, and Gloria Himmons, Case No. 12-20757-CR-Martinez– In this case, five defendants are charged with conspiracy to pay and receive health care kickbacks and substantive counts of paying and receiving kickbacks in connection with a federal health care program. According to the indictment, the defendants participated in a scheme involving Hollywood Pavilion (HP), a state-licensed psychiatric hospital that provides, among other things, inpatient psychiatric care and outpatient psychiatric care. Defendants Karen Kallen-Zury, Daisy Miller, and Michele Petrie are charged for devising and participating in a scheme to pay illegal bribes and kickbacks to patient brokers, and causing claims to be submitted for Medicare beneficiaries who were procured through bribes and kickbacks. Karen Kallen-Zury, the CEO and registered agent of HP, attempted to conceal the payment of bribes and kickbacks by creating false documents to make it appear as if legitimate services were being rendered. From at least 2003 through at least August 2012, HP billed Medicare more than $50 million for services that were never rendered, for patients that did not qualify for the services being billed, and for claims that were procured through bribes and kickbacks. If convicted, the defendants face up to twenty years for each count of the wire fraud charges, ten years for each count of health care fraud, and five years for each count of substantive kickback charges.
A companion civil case was also filed to restrain the assets of Kallen-Zury during the pendency of the criminal prosecution. The asset freeze is intended to preserve the defendant’s assets during the course of the prosecution in order to maximize the amount of money returned to the Medicare Program. The criminal case is being prosecuted by Trial Attorney Robert Zink of the Criminal Division’s Fraud Section. The civil action is being prosecuted by Assistant United States Attorney Mark Lavine and Trial Attorney Edward Crooke of the Civil Division’s Commercial Litigation Branch.
U.S. v. Rogelio Rodriguez and Raymond Aday, Case No. 12-20750-CR-Moreno – The indictment charges two defendants with conspiracy to commit health care fraud, conspiracy to pay and receive health care kickbacks, and substantive kickback charges. Defendant Rogelio Rodriguez was the owner and operator of Caring Nurse Home Health, Corp., which paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries. He then submitted false claims to Medicare, primarily for skilled nursing for patients who purportedly needed insulin injections twice a day. Defendant Raymond Aday was a patient recruiter for Caring Nurse Home Health, Corp., and was the owner and operator of Good Quality Home Health, Inc., which also paid kickbacks and bribes to patient recruiters and beneficiaries, and then submitted false claims to Medicare. Defendant Rogelio Rodriguez was also an owner of Good Quality Home Health, Inc. Through their scheme, the defendants caused the submission of $53 million in fraudulent billings to Medicare for skilled nursing diabetic care and physical therapy. As a result of these false claims, Medicare paid the companies $34 million. If convicted, the defendants face up to five years in prison for each kickback count. This case is being prosecuted by Trial Attorney Joseph Beemsterboer of the Criminal Division’s Fraud Section.
U.S. v. Sila Luis, Elsa Ruiz, and Myriam Acevedo, Case No. 12-20751-CR-Cooke – The indictment charges three defendants with conspiracy to commit health care fraud, conspiracy to pay and receive illegal health care kickbacks, and substantive kickback charges. Defendant Sila Luis was the owner and operator of LTC Professional Consultants, Inc., which paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries, and then submitted false claims to Medicare, primarily for skilled nursing for patients who purportedly needed insulin injections twice a day. Defendant Elsa Ruiz was the owner and operator of Professional Home Care Solutions, Inc., which also paid kickbacks and bribes to patient recruiters and beneficiaries, and then submitted false claims to Medicare. Defendant Elsa Ruiz was also an administrator at LTC Professional Consultants, Inc.. In that that capacity, Ruiz negotiated kickback payments and rates with patient recruiters. Defendant Myriam Acevedo was an office administrator at LTC and Professional Home Care and negotiated kickback rates and distributed kickback payments to patient recruiters on behalf of both companies. Through their scheme, the defendants caused the submission of $74 million in fraudulent billings to Medicare for skilled nursing diabetic care and physical therapy. As a result of these false claims, Medicare paid the companies $50 million. If convicted, the defendants face up to ten years in prison for each count of health care fraud, and five years in prison for each count of the kickback charges.