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Miami Man Pleads Guilty in $123 million Medicare Fraud Scheme

John Commins, for HealthLeaders Media, August 17, 2009

The Miami operator of 11 shell corporations that billed Medicare for $123 million in bogus durable medical equipment claims has pleaded guilty to Medicare fraud in federal court.

Reinaldo Guerra will be sentenced on Nov. 13.

According to the documents attached to the plea, Guerra owned 11 corporations that purported to supply DME to Medicare beneficiaries. He used straw owners to disguise his control over the companies and submitted approximately $123 million in fraudulent claims to Medicare for DME that had not been ordered by a physician nor delivered to a Medicare beneficiary. Based on those claims, Medicare paid Guerra’s DME companies $35 million.

Federal prosecutors have long acknowledged that Miami and South Florida are a Medicare fraud hotbed.

In March 2007, the Department of Justice established a Medicare fraud strike force in Southern Florida that has filed about 100 indictments charging more than 170 people with fraud. However, there is also concern that the fraudsters are migrating to other parts of Florida and the country as investigations intensify in South Florida.

In May, U.S. Attorney Eric Holder said that during the first year of strike force operations in Miami, the federal government estimated that billing for durable medical equipment fell by $1.75 billion in claims and $334 million in payments.


John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.

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