Becker's Hospital Review has an article about a recent Miami health care fraud case which resulted in one of the lengthiest sentences I've seen handed out in this type of case. This multi-defendant case involved numerous states and different kinds of health care frauds including Medicare-HIV infusion (i.e., the insertion of a needle into a patient's vein), stolen identities, and fraudulent billing to Medicare Advantage Program in 29 states.
The article can be found at the following link:
Miami Resident Sentenced to 22 Years' Imprisonment for Healthcare Fraud | Legal and Regulatory
The article summarizes the case in which on January 27, 2010 lead defendant Michel De Jesus Huarte was sentenced to 264 months' incarceration for various offenses including conspiracy to commit Medicare fraud, conspiracy to commit money laundering, and aggravated identity theft.
For their respective roles in two fraud schemes, the other co-defendants' sentences were: (1) Alyd Dazza - 179 months' imprisonment, (2) Ricco Dazza - 115 months' imprisonment, (3) Monika Blacio - 78 months' imprisonment, (4) Dayron Porrata - 84 months' imprisonment, (5) Wally Proenza - 17 months' imprisonment, and (6) Vicente Gonzalez - awaiting sentencing.
Medicare HIV-Infusion Fraud Scheme
The first conspiracy alleged that Mr. Huarte and other conspirators operated and controlled 6 purported medical clinics in Miami Dade County. According to the Indictment, these clinics submitted at least $50.2 million in false and fraudulent claims to Medicare for infusion therapy, injection therapy, and other expensive medical treatments designed treat Medicare beneficiaries suffering from a wide variety of ailments including cancer, HIV, AIDS, chronic pain, and varicose veins. Based on these fraudulent claims, Mr. Huarte and his conspirators were paid at least $19.2 million.
To conceal their involvement in the scheme, Mr. Huarte and his conspirators allegedly recruited nominee or “straw” owners for each company, and paid them large sums of cash to sign the corporate records, bank records, and other business documents.
The six purported clinics involved in the fraud were: Zigma Medical Care, Inc., Tender Loving Care Medical Center, Inc, Professional Medical Health, Inc., Metro Med Care, Inc., San Diego Medical & Rehab Center, Inc., and Eulogia's Diagnostic Medical Center, Inc.
Multistate Medicare Advantage Fraud Scheme
Mr. Huarte was involved in a second Medicare fraud conspiracy along with co-defendants Alyd Dazza, Ricco Dazza, Monika Blacio, and Dayron Porrata. In the second conspiracy, Mr. Huarte and his conspirators expanded the Medicare fraud scheme by opening 29 medical clinics in Florida, Georgia, Louisiana, North Carolina, and South Carolina. Many of the clinics were allegedly simply P.O. Boxes, or empty, abandoned storefronts.These medical clinics collectively submitted approximately $55.5 million in alleged false and fraudulent claims to various private insurance companies that offered coverage to Medicare beneficiaries through Medicare Advantage programs. Based on these false and fraudulent claims, the Medicare Advantage programs claimed they paid approximately $14.6 million dollars to the "sham" clinics. A substantial portion of the billings were for expensive cancer and HIV medications that are often administered via infusion treatments.
This case reveals how the black market in Medicare and Medi-Cal cards works. According to court documents, defendant Wally Proenza stole and sold the identities of 718 Medicare beneficiaries living in at least five (5) states. Mr. Proenza allegedly stole the identities from his employer where he had access to personal identifying data of millions of Medicare beneficiaries. Mr. Proenza then sold the identifications to co-defendant Dayron Porrata.
Mr. Porrata then transferred the identifications to other conspirators, including Mr. Huarte, who used the Medicare beneficiaries identifications to submit false and fraudulent claims through the twenty-nine (29) sham clinics located in Florida, Georgia, Louisiana, North Carolina, and South Carolina.
Related court documents and information may be found on the website of the United States District Court for the Southern District of Florida at www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov.
Any questions or comments should be directed to experienced health care fraud attorney Tracy Green at tgreen@greenassoc.com. Tracy Green is a principal at Green & Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers in compliance, Medicare fraud, Medi-Cal fraud, and health care fraud related matters. Their website is: http://www.greenassoc.com/
