Three Miami Area Doctors, Six Others Charged In $56 Million Health Care Fraud Schemes

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May 29, 2008 Thursday 12:25 AM EST

LENGTH: 1470 words

HEADLINE: THREE MIAMI AREA DOCTORS, SIX OTHERS CHARGED IN $56 MILLION HEALTH CARE FRAUD SCHEMES

BYLINE: US Fed News

DATELINE: WASHINGTON

The U.S. Department of Justice's Criminal Division issued the following news release:

Three Miami area doctors and six others have been charged in four separate indictments for their roles in HIV infusion fraud schemes totaling $56 million, the Department of Justice Criminal Division and U.S. Attorney's Office for the Southern District of Florida announced today.

One indictment alleges that between August 2002 and March 2004, Dr. Ronald Harris, 57, and Enrique Gonzalez, 62, conspired to submit approximately $24.5 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at Physicians Med-Care and Physicians Health Med-Care, HIV infusion clinics that Harris and Gonzalez allegedly controlled. Infusion clinics serve HIV patients by providing prescribed medications intravenously. As part of the scheme, Gonzalez caused the payment of cash kickbacks to Medicare beneficiaries in exchange for the patients signing documents stating that they had received the treatments being billed to Medicare when such treatments were not provided and not medically necessary. Harris worked as the doctor at Physicians Med-Care and Physicians Health Med-Care and would order unnecessary tests, sign medical forms and authorize treatments to make it appear that legitimate medical services were being provided to Medicare beneficiaries, when in reality the services were not actually provided and were not medically necessary. The indictment also alleges that Harris and Gonzalez laundered the proceeds of their crimes by sending the proceeds to a purported medical company that was actually owned and controlled by Harris, Gonzalez and their co-conspirators.

Harris and Gonzalez are charged with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and one count of conspiracy to launder the proceeds of their crimes. Harris was also charged with three counts of submitting false claims to the Medicare program and two counts of money laundering. Gonzalez was charged with three counts of money laundering and one count of making a false statement to agents of the United States. In addition, the indictment seeks forfeiture of assets held by Harris and Gonzalez. If convicted, Harris and Gonzalez each face a maximum sentence of 60 years in prison.

A separate indictment alleges that between May 2003 and January 2004, Juan Carlos Castaneda, 47, Dilcia Marinez, 56, and Luis Frias, 60, conspired to submit approximately $14 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at G&S Medical Center, an HIV infusion clinic operated by Castaneda, Marinez and Frias. As part of the scheme, Castaneda, Marinez and Frias allegedly retained physicians and physicians' assistants to work at G&S Medical to make it appear that legitimate HIV infusion services were being provided and hired a physician's assistant to train the physicians to make it appear that legitimate and appropriate medical services were being provided. Castaneda, Marinez and Frias would pay kickbacks to Medicare beneficiaries in exchange for the patients signing documents stating that they received the treatments being billed to Medicare. Such treatments were not provided or medically necessary. The indictment also alleges that Castaneda, Marinez and Frias laundered the proceeds of their crimes by sending the funds to sham management and marketing companies owned and controlled by their co-conspirators and by sending proceeds to companies they owned and controlled themselves. Furthermore, the indictment alleges that Castaneda and Marinez structured financial transactions of less than $10,000 to avoid financial reporting requirements.

Castaneda, Marinez and Frias are charged with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and one count of conspiracy to launder the proceeds of their crimes. In addition, Marinez was charged with five counts of money laundering, Frias with three counts of money laundering and Castaneda with two counts of money laundering. Castaneda and Marinez were also each charged with three counts of structuring currency transactions for the purpose of evading reporting requirements. If convicted, Castaneda faces a maximum of 90 years in prison, Marinez faces a maximum of 140 years in prison, and Frias faces a maximum of 85 years in prison.

In another indictment involving a similar scheme, Jose Garcia, 53, and Nayda Freire, 60, allegedly conspired between April 2003 and November 2003 to submit approximately $10.9 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at Global Med-Care Corp., an HIV infusion clinic operated by Garcia and Freire. As part of the scheme, Garcia, Freire and their co-conspirators also allegedly retained physicians and physicians' assistants at Global Med-Care to make it appear legitimate HIV infusion services were being provided and to train the physicians to make it appear that legitimate and appropriate medical services were being provided. They would then cause the payment of cash kickbacks to beneficiaries who signed documents stating they had received the non-existent and medically unnecessary treatments. The indictment also alleges that Garcia and Freire laundered the proceeds of their crimes by sending proceeds to sham management and marketing companies owned and controlled by their co-conspirators.

Garcia and Freire are charged with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; one count of conspiracy to launder the proceeds of their crimes; and four counts of money laundering. Garcia also was charged with four counts of submitting false claims to the Medicare program. If convicted on all charged counts, Garcia faces a maximum of 85 years in prison. Freire faces a maximum of 65 years in prison if convicted on all charges.

Another separate indictment alleges that between November 2002 and April 2004, Dr. Carlos Contreras, 60, and Dr. Ramon Pichardo, 58, conspired to submit approximately $6.8 million in false and fraudulent claims to the Medicare program for HIV infusion services allegedly provided at C.N.C. Medical Corp., an HIV infusion clinic at which Contreras and Pichardo were both physicians. As part of the scheme, Contreras, Pichardo and their co-conspirators would cause unnecessary tests to be ordered, medical forms to be signed and treatments to be authorized to make it appear that legitimate HIV infusion services were being provided at C.N.C Medical. They would then cause the payment of cash kickbacks to Medicare beneficiaries in exchange for the patients signing documents stating that they received the treatments being billed to Medicare, when in reality such treatments were not provided and not medically necessary. The indictment also alleges that Contreras and Pichardo laundered the proceeds of their crimes by sending proceeds to sham management and marketing companies owned and controlled by their co-conspirators and by sending proceeds to a company owned and controlled by Pichardo.

Contreras and Pichardo are charged with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; one count of conspiracy to launder the proceeds of their crimes; and three counts each of money laundering. Contreras was also charged with three counts of submitting false claims to the Medicare program. If convicted on all charged counts, Contreras faces a maximum of 70 years in prison. Pichardo faces a maximum of 55 years in prison if convicted.

The cases are being prosecuted by Trial Attorneys Hank Bond Walther, John K. Neal and N. Nathan Dimock of the Criminal Division's Fraud Section, and Laurel Loomis Rimon and Constantine Lizas of the Criminal Division's Asset Forfeiture and Money Laundering Section. Investigative assistance is being provided by the FBI and the Department of Health and Human Services, Office of the Inspector General. The cases were brought as part of the Medicare Fraud Strike Force that has been operating in Miami since March 2007. The Strike Force is led by Deputy Chief Ogrosky of the Criminal Division's Fraud Section in Washington, D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

LOAD-DATE: May 30, 2008