Feds charge hundreds in Miami, U.S. with Medicare prescription and other scams

June 18--The West Miami drug store was called E-Z Pharmacy. A more apt name would have been "E-Z Money."

The former owners -- Eklis Almanza and husband Juan E. Diaz Gonzalez -- pocketed $4.8 million from the taxpayer-funded Medicare program by submitting bogus claims for prescription drugs from 2008 to 2014 that none of their customers ever needed or received, according to federal prosecutors.

Almanza, her husband and another partner, Andres F. Rojas, "falsely" claimed that the drugs were "medically necessary, prescribed by a doctor and ... provided to Medicare beneficiaries by E-Z Pharmacy," according to an indictment.

The couple are among about 80 people charged this week in Miami federal court with bilking Medicare, including dozens accused of defrauding the Part D prescription drug program that was implemented a decade ago during the Bush administration.

The Miami arrests -- carried out by squads of FBI and Health and Human Services agents -- are part of this week's nationwide take-down of about 200 Medicare fraud offenders in states across the country, extending to Alaska. The Justice Department and U.S. attorney's office in Miami plan to hold parallel news conferences Thursday to spotlight the latest schemes to fleece the Medicare program, which continues to be plagued by billions of dollars in losses to fraud every year.

Since its inception in 2006, Part D has gained popularity because it helps deliver prescription drugs to tens of millions of elderly and disabled Americans, who buy them from pharmacies reimbursed by private insurers funded by the Medicare program. But predictions of potential fraud have turned out to be accurate because numerous pharmacies submit false prescriptions for anti-depressant, anti-inflammatory and other drugs.

In several of the latest criminal cases in Miami, pharmacy owners paid kickbacks to patients or patient recruiters to generate a steady stream of Medicare numbers that were used to fleece the program. That has been a longstanding practice in South Florida's Medicare rackets, including services for medical equipment, HIV infusion therapy, home healthcare for diabetics, mental health sessions and, of late, Part D prescription drugs.

In 2013, ProPublica reporters highlighted the vulnerability of the Part D program, noting that insurance companies must pay for prescriptions issued by any licensed prescriber and filled by any willing pharmacy within 14 days.

"Insurers generally must cover even suspicious claims before investigating, an approach called 'pay and chase,''' the online, investigative news organization reported. "By comparison, these same insurers have more time to review questionable medication claims for patients in their non-Medicare plans."

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