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Editor: Mike Bothwell
Profession: Qui Tam Attorney

Category: Settlements and Verdicts

A Miami federal jury has convicted a physician and the owners and operators of two durable medical equipment companies as well as a home health care agency of Medicare fraud.

After a five week trial, the jury found Maria T. Hernandez (Mayte), 50, Marta F. Jimenez, 67, Maivi Rodriguez, 34, and Ana Caos, M.D., 62, guilty on all charged counts, which included conspiracy to defraud the U.S. government, to cause the submission of false claims to Medicare, and to solicit and receive kickbacks; and conspiracy to commit health care fraud. Defendants Hernandez, Jimenez and Rodriguez also were found guilty on six counts of receiving kickbacks in exchange for referring Medicare patients. As a result, Hernandez faces a maximum of 35 years in prison, Rodriguez and Jimenez each face a maximum of 25 years in prison, and Caos faces a maximum of 15 years in prison. Sentencing is set for May 16, 2008.

At trial, the Medicare Strike Force attorneys presented testimony that patients were falsely diagnosed with chronic obstructive pulmonary disease and prescribed unnecessary aerosol medications, including "compounded" medications delivered by Miami-area pharmacies. Compounded medications are those mixed in the pharmacy, instead of being purchased from a pharmaceutical manufacturer. Testimony revealed that one of the "pharmacists" was unlicensed and had been trained as an auto mechanic.

The scheme involved more than sixty Medicare patients. Evidence showed that between December 1997 and January 2007, the defendants directly billed Medicare more than $1.6 million dollars for medical equipment for these same patients. Moreover, between February 2001 and June 2003, Medicare was billed $487,783 by complicit pharmacies for unnecessary aerosol prescriptions for these patients. In exchange, the defendants received approximately $150,000 dollars from the pharmacy owners. The pharmacy owners have also been sentenced to federal prison, and the fraudulent pharmacies were shut down in June 2003 following raids by the FBI and U.S. Department of Health and Human Services' Office of the Inspector General (HHS-OIG).

Patients testified that they were paid cash kickbacks to accept delivery of the unnecessary medication and medical equipment. One Medicare beneficiary testified that he donated the medication to charity ; another testified that she threw it in the trash. Former physician, Pedro Cuni, who is serving time in prison for Medicare fraud, testified that he was paid $50 a piece to write prescriptions for the patients controlled by these defendants.

Trial evidence established that prescriptions came from former physician Pedro Cuni (now serving time in prison fo Medicare fraud, who testified he was paid $50 a piece for prescriptions) and Defendant Caos, who wrote prescriptions for unnecessary compounded aerosol medication and its related medical equipment.

The case was brought as part of the Medicare Fraud Strike Force that has been operating since March of 2007. It was prosecuted by Deputy Chief Kirk Ogrosky and Trial Attorney John S. (Jay) Darden of the Fraud Section of the Criminal Division, with assistance from the FBI and HHS-OIG. The Medicare Strike Force is led by Deputy Chief Ogrosky of the Fraud Section of the Criminal Division in D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida. The Strike Force operates out of the federal Health Care Fraud Facility in Miramar, Fla. Since its inception, the Strike Force has brought charges against 120 defendants, resulting in 101 convictions.