Friday, June 28, 2013

Medical Supply Owner & Marketer Sentenced In Health Care Fraud And Kickback Case Involving Power Wheelchairs Billed to Medicare

On June 24, 2013, two individuals were sentenced in a health care fraud case involving power wheelchairs.  Jose Melendez, the owner and operator of Oceanside Medical Services, was sentenced to 18 months in prison by Judge Huff, U.S. District Court for the Southern District of California (San Diego), for his involvement in a health care fraud conspiracy that resulted in over $1 million in false claims to the Medicare trust fund. Melendez was also ordered to pay $593,429.81 in restitution, and will be on supervised release for three years after completing his custodial sentence.

Mr. Melendez plead guilty in a plea agreement to conspiracy to pay and receive health care kickbacks and defraud in violation of 18, U.S.C. Section 371 in which the maximum penalty is five years in custody; $250,000 fine; 3 year of supervised release; and mandatory restitution.  Thus, a sentence of 18 months indicates a reduction in the potential sentence.

This case involved the sale of power wheelchair prescriptions in order to obtain Medicare reimbursement for power wheelchairs that the patients allegedly did not need and, in some cases, the patients said they did not want. It was alleged that two of Mr. Melendez’s co-defendants and alleged co-conspirators, Dr. Irving Schwartz and Gloria Hernandez, traveled to El Centro, California in search of elderly Medicare patients.

Dr. Schwartz allegedly wrote fraudulent prescriptions for the patients to obtain power wheelchairs, even though the patients did not need the equipment and could walk without assistance, and collected a $300 cash kickback in exchange for each  power  wheelchair  prescription.  Ms. Hernandez  then  sold  the  fraudulent  power  wheelchair prescriptions to Mr. Melendez, charging him $1,000 per fraudulent prescription.

Mr. Melendez, in turn, sold some of the power wheelchair prescriptions to others, charging an additional mark-up on each prescription. As the last step, Mr. Melendez and others submitted  the  fraudulent  prescriptions  to  Medicare  for  reimbursement,  billing  up  to $5,865 for each power wheelchair.

According to the plea, Dr. Schwartz wrote at least 186 power wheelchair prescriptions for Medicare beneficiaries in exchange for more than $55,000 in bribes and kickbacks. Mr. Melendez, the owner and operator of Oceanside Medical Services, purchased these 186 fraudulent prescriptions and used them to submit over $830,000 in false claims to Medicare.

Ms. Hernandez was sentenced to 6 months home confinement, and ordered to pay $160,000 in restitution to Medicare.

Dr. Schwartz is scheduled to be sentenced on August 19, 2013, before Judge Huff.  

In a separate and related case, Aristeo and Laura Tavares, who were charged in a separate case, submitted more than $250,000 in false Medicare claims based on Dr. Schwartz’s fraudulent prescriptions.  On March 27, 2013, Aristeo and Laura Tavares were sentenced to time served (1 day in custody), and ordered to pay $182,860.77 in restitution to the Medicare trust fund. 

Posted by Tracy Green, Esq.
Contact: 213-233-2260


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.