67 Charged in Ga-Fl Health Care Fraud Scheme

The Justice Department announced this week that a significant health care fraud enforcement operation across Florida and Georgia led to charges against a total of 67 individuals across four federal districts for their alleged involvement in various schemes to defraud Medicare and Medicaid.  The conduct allegedly resulted in more than $160 million in fraudulent billings.  Those charged included physicians as well as other medical and business professionals. In addition, in the state of Florida, 16 defendants, including one licensed mental health professionals, have been charged with defrauding the Medicaid program out of over $1.2 million.  Florida’s Medicaid Fraud Control Unit (MFCU) investigated these cases.

The charges announced today aggressively target schemes alleged to have billed Medicare, Medicaid and private insurance companies for medically unnecessary services, such as home health, prescriptions drugs and durable medical equipment.

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI and U.S. Health and Human Services-Office of Inspector General (HHS-OIG).  In addition, the operation includes the participation of various other federal law enforcement agencies and state MFCUs. The Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI) also announced today that all appropriate administrative actions would be taken based on these charges.

“The defendants charged today allegedly bilked the American people to the tune of millions in fraudulent billings,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division.  “All Americans should stand with the Department as we fight the fight against these unscrupulous schemes in Florida, Georgia, and across the country.”

“Anyone who seeks to exploit our federal healthcare programs for personal gain and illicit profit should know that we will prosecute them to the fullest extent of the law,” said U.S. Attorney Maria Chapa Lopez for the Middle District of Florida.  “The American people must have confidence in the healthcare services for which they pay and receive, and trust in those who administer them.”

“Health care programs provide vital services to Americans,” said U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida.  “Those who perpetuate these pervasive health care fraud schemes steal taxpayer dollars from intended beneficiaries and threaten the viability of government programs.  We commend the coordinated and continued efforts of our federal law enforcement partners to root out fraud and abuse in our healthcare system.”

“The drug dealer stereotype involves violent gang members peddling poison in our streets, but often the illicit dealers wear white coats and work in medical offices,” said U.S. Attorney Bobby L. Christine for the Southern District of Georgia.  “People who violate medical oaths and ethical codes to turn illegal profits by fueling the opioid crisis will find prosecutors and investigators working tirelessly to swap their lab coats for prison uniforms.”

“Being a healthcare professional in the Medicare program is a privilege, not a right.  When physicians and other healthcare providers put their own financial gain above patient well-being and honest billing of government health programs, they violate the basic trust that taxpayers extend to healthcare professionals,” said Special Agent in Charge Derrick L. Jackson of the HHS-OIG Atlanta Regional Office.  “Today’s arrests put corrupt medical professionals on alert that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal health care programs.”

“FBI Atlanta and its Savannah Resident Agency are proud to have participated in this nationwide effort to help protect the much needed federal funds that Medicare provides,” said Special Agent in Charge Chris Hacker of the FBI’s Atlanta Field Office.  “When providers are driven by greed and abuse the Medicare program, every tax paying citizen is a victim, especially those who use the federal funds for their health care needs. Improper billing inflates costs and the FBI and its law enforcement partners are determined to hold those who do it accountable.”

“The FBI and its federal, state and local partners are working tirelessly every day to detect and combat schemes like those announced today,” said Special Agent in Charge George L. Piro of the FBI’s Miami field office.  “Despite our efforts, we still need the public’s help in reporting suspicious activity.  If anyone suspects they are a victim of health care fraud please call your local FBI office or the HHS Office of Inspector General.”

“We commend the law enforcement partnerships for this operation and pledge to continue our commitment to protecting the nation’s federally funded healthcare system and the people who depend on it,” said Special Agent in Charge Michael McPherson of the FBI’s Tampa Division.

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Among those charged in partnership between Strike Force attorneys and U.S. Attorney’s Offices are the following:

In the Northern District of Georgia, one defendant was charged.

Donald Graham, 49, of Smyrna, Georgia, a former employee of a metro Atlanta hospital, has been charged for allegedly stealing and selling individually identifiable health information that was used to submit fraudulent claims to Medicaid.  Assistant U.S. Attorney Jeffrey A. Brown of the Northern District of Georgia and Assistant Attorney General Elizabeth Grofic of the Georgia Medicaid Fraud Control Unit are handling the case.

In the Southern District of Georgia, six defendants were charged and one civil complaint was filed.

Jenna Savage, 26 of Port Wentworth, Georgia; Norman Lee Burnsed, 27 of Port Wentworth, Georgia; Tucker Chambers, 21 of Ellabell, Georgia; Macaila Brown, 22 of Rincon, Georgia; and Cameron Hilliard, 26 of Savannah, Georgia, were indicted by a federal grand jury in Savannah with conspiracy charges under the Controlled Substances Act relating to the distribution of oxycodone, Adderall, alprazolam, and clonazepam. Assistant U.S. Attorneys Katelyn Semales and Marcela Mateo are prosecuting the case.

David L. Williford, 59, of Rincon, Georgia, a pharmacist, was charged by information with one count of acquiring a controlled substance (oxycodone) by misrepresentation, fraud, or forgery. Assistant U.S. Attorney Jonathan A. Porter is prosecuting the case.

Darien Pharmacy and Janice Ann Colter, 62, of Darien, Georgia, a pharmacist, were named in a civil complaint filed in federal court that accused Darien Pharmacy and Colter of filling prescriptions for controlled substances that the defendants knew or should have known were not issued for legitimate medical reasons, and by a provider not acting with the regular course of professional practice. Assistant U.S. Attorneys Bradford C. Patrick and Jonathan A. Porter are prosecuting the case.

In the Middle District of Florida, two defendants were charged.

Teresa Johnson, 53, of Lecanto, Florida, was charged by information with one count of conspiracy to commit health care fraud and submit fraudulent claims to Medicare, Medicaid, Tricare and ChampaVA.  According to the indictment, Johnson owned and operated Tri-County Medical Billing and, from November 2016 through October 2018, knowingly submitted false and fraudulent claims on behalf of a medical doctor who owned clinics in Crystal River, Spring Hill and Celebration, Florida.  HHS-OIG, FBI, DoD-OIG, VA-OIG and the Florida Office of Attorney General Medicaid Fraud Control Unit investigated the case. Assistant U.S. Attorney Kelley Howard-Allen is prosecuting the case.

Marcus Anderson, 34, of St. Petersburg, Florida, was charged in a thirteen-count indictment with health care fraud and aggravated identity theft for allegedly stealing rendering providers’ identities to submit more than $1.2 million in false and fraudulent claims to Medicaid. HHS-OIG and the Florida Office of Attorney General’s Medicaid Fraud Control Unit investigated the case. Assistant U.S. Attorney Kristen A. Fiore will prosecute the case.

In the Southern District of Florida, 42 defendants were charged.

Ana Maria Fernandez, 62, and Berta Leon, 69, of Miami, Florida, were charged with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendants participated in a conspiracy to use their company ABC Medical Solutions Corp. of Miami, to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies, including ACM Home Health Corp. of Miami and TC Home Health Care Inc. of Hialeah, Florida.  This case was investigated by HHS-OIG and the FBI.  Assistant U.S. Attorney Timothy J. Abraham of the Southern District of Florida is prosecuting this case.

Sara Tania Ruiz, 55, of Hialeah, and Maria Laura Prieto, 60, of Miami, were charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendants participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies, including ACM Home Health Corp. of Miami and TC Home Health Care Inc. of Hialeah.  This case was investigated by HHS-OIG and the FBI.  Assistant U.S. Attorney Timothy J. Abraham of the Southern District of Florida is prosecuting this case.

Marisol Padilla, 48, of Hialeah, was charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendant participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to TC Home Health Care of  Hialeah. This case was investigated by HHS-OIG and the FBI.  Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.

Juan Jose Mesa, 58, and Madelaine Varona, 47, both of Miami, owners and/or operators of All Excellent OT-PT Service LLC of Miami and Cruz Healthcare Corp. of Miami, respectively; Sandra Cardona, 47, of Hialeah, an allegedly unlicensed therapist; and Silvia Salvatori, 67, of Pembroke Pines, Florida, a licensed massage therapist, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud.  Mesa and Varona were also charged with five and six counts of health care fraud, respectively.  The charges stem from Mesa’s and Varona’s alleged roles in a scheme to defraud Part A of the Medicare program of more than $4 million by billing for home health services that were not rendered and paying kickbacks to patient recruiters in exchange for patient referrals.  Cardona and Salvatori, who were allegedly not licensed to provide physical therapy, accepted payment from a licensed physical therapist, paid by their co-conspirators, in exchange for allegedly obtaining signed patient visitation forms from Medicare beneficiaries used to submit false and fraudulent claims.  This case was investigated by HHS-OIG and the FBI.  The case is being handled by Assistant U.S. Attorney Kevin Larsen of the Southern District of Florida.

Ivan Bejerano, 49, of Miami, was charged by indictment with seven counts of health care fraud and one count of conspiracy to commit health care and wire fraud.  According to the indictment, Dynamic Physical Rehab Inc. (Dynamic) was a Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services. From June 2017 through July 2019, Bejerano allegedly submitted and caused the submission of claims, via interstate wires, totaling approximately $2.5 million that falsely and fraudulently represented that various health care benefits, primarily physical therapy, were medically necessary, prescribed by a doctor, and had been provided by Dynamic to insurance beneficiaries of Blue Cross Blue Shield (BCBS).  This case was investigated by the FBI.  This case is being prosecuted by Assistant U.S. Attorney Shannon Shaw of the Southern District of Florida.

Jocelyn De La Caridad Perez, 41, and Joaquin Guevara, 46, both of Miami, were charged by indictment with one count of conspiracy to receive health care kickbacks.  Perez was also charged with one count of conspiracy to commit health care fraud and wire fraud, and Guevara was also charged with three counts of receipt of kickbacks in connection with a federal health care program.  According to the indictment, Perez was an administrator of Joe Rehabilitation and Diagnostic, Inc. (Joe Rehab), an outpatient rehabilitation facility in Doral, Florida, that purportedly provided therapy services to Medicare beneficiaries.  As part of the fraudulent scheme, Perez allegedly conspired with others to pay kickbacks and bribes for the referral of Medicare beneficiaries to Joe Rehab so their information could be used to submit fraudulent claims to Medicare for services purportedly provided, regardless of whether the Medicare beneficiaries needed or received the services.  This case was investigated by HHS-OIG and the FBI.  Assistant U.S. Attorney Anne P. McNamara of the Southern District of Florida is prosecuting this case.

Deivys Ernesto Alvarez, 48, of Hialeah, was charged by indictment with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud.  According to the indictment, Alvarez was the owner of Diagnostic Center of Medley Inc., a Miami medical clinic.  AP & JL Medical Center Inc. (AP & JL) was another Miami medical clinic that purportedly provided private insurance beneficiaries with various medical treatments and services.  Alvarez and co-conspirators allegedly recruited and paid Comcast Corp. and Telemundo Corp. employees, through Diagnostic Center of Medley Inc., and referred those employees and/or the employees’ personal information to AP & JL to fraudulently bill BCBS.  Alvarez and his co-conspirators allegedly submitted and caused the submission of false and fraudulent claims, via interstate wires, totaling approximately $800,500. This case was investigated by HHS-OIG and the FBI.  This case is being prosecuted by Assistant U.S. Attorney Timothy J. Abraham of the Southern District of Florida.

Elba Cobos Baile, 60, and Yolanda Castano, 55, both of Miami, were charged by indictment with four counts of health care fraud and one count of conspiracy to commit health care fraud and wire fraud.  Cobos and Castano were the owners and operators of Pharmacy Solution, a retail pharmacy in Miami-Dade County. The indictment alleges that from on or about March 1, 2012 to September 17, 2014, Cobos and Castano submitted and caused the submission of claims, via interstate wires, 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 Pharmacy Solution to Medicare beneficiaries.  As a result of these false and fraudulent claims, Medicare prescription drug plan sponsors allegedly made payments funded by the Medicare Part D Program to the corporate bank accounts of Pharmacy Solution in the approximate amount of at least $2.1 million. This case was investigated by HHS-OIG and the FBI.  Assistant U.S. Attorney Christopher J. Clark of the Southern District of Florida is prosecuting this case.

Tania Rodriguez, 48, and Rafael Vidal, 61, both of Miami, were charged by indictment with one count of conspiracy to commit healthcare and wire fraud and seven counts of health care fraud.  According to the indictment, the defendants participated in a conspiracy to use their company, American United Pharmacy Corp. of Miami, to offer and pay kickbacks for the referral of Medicare beneficiaries to their pharmacy, and to submit false and fraudulent claims to Medicare for prescription drugs that were not provided to Medicare beneficiaries.  Assistant U.S. Attorney David Turken of the Southern District of Florida is prosecuting this case.

Ricardo Ignacio Perez, 54, and Ricardo Perez-Leon, 31, both of Miami, the owners and operators of three Miami pharmacies, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud; one count of conspiracy to defraud the United States and pay and receive health care kickbacks; and three counts of health care fraud.  The indictment alleges that the defendants participated in a scheme to pay kickbacks and bribes to patient recruiters and to fraudulently bill Medicare drug plan sponsors for prescription medications.  The indictment alleges that, during the course of the fraudulent scheme, the defendants received approximately $5.3 million from Medicare drug plan sponsors for prescription medications that were medically unnecessary, never provided and/or never purchased by the defendants’ pharmacies.  This case was investigated by HHS-OIG and the FBI.  The case is being prosecuted by Trial Attorneys Sara Clingan and Tim Loper of the Fraud Section.

Steven Kahn, 61, of Boca Raton, and Pamela Edwin, 33, of Delray Beach, the owner and office manager, respectively, of a Broward county telemedicine company, were charged by indictment with one count of conspiracy to commit health care fraud and wire fraud and three counts of wire fraud. Kahn was also charged with five counts of money laundering.  The indictment alleges that the defendants paid kickbacks and bribes to physicians in exchange for signing doctors’ orders, and that the defendants then sold the doctors’ orders to Medicare providers who used the orders to submit approximately $39 million in fraudulent claims to Medicare.  This case was investigated by HHS-OIG and the FBI.  The case is being prosecuted by Trial Attorneys Sara Clingan and Catherine Wagner of the Fraud Section.

Jordan Karlick, 33, of Boca Raton, Michael Moranz, 32, of Lake Worth, and Jordan Chibnick, 36, of Plantation, the owners of Palm Beach durable medical equipment (DME) companies, were charged by indictment with one count of conspiracy to commit healthcare fraud and wire fraud, one count of conspiracy to defraud the United States and pay kickbacks, four counts of health care fraud, and three counts of payment of kickbacks.  The indictment alleges that the defendants paid kickbacks and bribes in exchange for signed doctors’ orders for DME, which the defendants used to fraudulently bill Medicare for over $23 million.  The indictment alleges that defendants sought to impede Medicare beneficiary’s ability to return DME that they did not want or need to defendants’ companies, so that defendants could continue to bill Medicare for that DME.  This case was investigated by HHS-OIG and the FBI.  The case is being prosecuted by Trial Attorneys Sara Clingan and Catherine Wagner of the Fraud Section.

Richard S. Mallia, D.P.M., 55, a podiatrist, was charged by indictment with one count of conspiracy to defraud the United States and to receive kickbacks, one count of conspiracy to commit health care fraud and wire fraud, and three counts of health care fraud, for his role in a health care fraud conspiracy that caused a loss of approximately $7.7 million to the Medicare program.  The indictment alleges that Mallia accepted cash kickbacks in exchange for writing medically unnecessary home health prescriptions and also participated in a scheme to submit claims to Medicare for relatively expensive foot procedures that he never performed.  This case was investigated by HHS-OIG, the FBI, and United States Secret Service. The case is being prosecuted by Trial Attorney Alexander Pogozelski of the Fraud Section.

Peter Port, 64, of Boca Raton, Brian Dublynn, 62, of Fort Lauderdale, and Jennifer Sanford, 57, of Hollywood, were charged for their alleged participation in a scheme to defraud private health insurance companies.  Port, Dublynn and Sanford were each charged with one count of conspiracy to commit health care fraud and wire fraud and four counts of health care fraud.  In addition, Port and Dublynn were each charged with one count of conspiracy to commit money laundering and five counts of money laundering.  The defendants caused Safe Haven Recovery Inc. (Safe Haven), a substance abuse treatment facility in Miami, and several clinical laboratories to submit false and fraudulent claims to health insurance plans for addiction treatment services that were not provided as billed and laboratory tests that were not medically necessary. This case was investigated by the FBI.  This case is being handled by Trial Attorney David A. Snider of the Fraud Section.

Maribel Sera, 51, of Hialeah, was charged by information with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the information, the defendant participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to TC Home Health Care of Hialeah. HHS-OIG and the FBI investigated this case.  Assistant U.S. Attorney Timothy J. Abraham is prosecuting this case.

Francisco Abreu Tartabull, 53, of Miami, was charged by indictment with conspiracy to commit health care fraud and wire fraud in connection with his role in a $2.1 million private insurance fraud scheme.  According to the indictment, Tartabull was the owner and operator of South Dade Medical Center Inc. (South Dade), a Miami medical clinic that purportedly provided Blue Cross Blue Shield insurance beneficiaries with various medical treatments and services.  As part of the fraudulent scheme, Tartabull and his co-conspirators submitted more than $2.1 million in fraudulent claims to Blue Cross Blue Shield.  These claims falsely represented that the benefits Tartabull’s clinic had billed insurance for were medically necessary, prescribed by a doctor, and had been provided by South Dade to these beneficiaries.  As a result of these false claims, Blue Cross Blue Shield paid Tartabull’s clinic more than $920,000.  Tartabull then used this ill-gotten money for his own personal use and benefit, and to further the fraud.  The FBI investigated this case.  Assistant U.S. Attorney Anne P. McNamara is prosecuting this case.

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The charges and allegations contained in the indictments are merely accusations.  The defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

The Fraud Section leads the Medicare Fraud Strike Force (MFSF), which is part of a joint initiative 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.  Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.