Miami Medicare Scammers Sentenced

Three Miami-area medical professionals were ordered to prison this week for their roles in a $23 million Medicare fraud scheme involving bogus billings for HIV infusion therapy, the U.S. Departments of Justice and Health and Human Services has announced. 

Physician assistant Jose Diaz, 62, and medical assistants Lisandra Aguilera, 40, andEstrella Rodriguez, 43, received prison terms Monday of four-and-a-half years, five years, eight months, and four-years, eight months, respectively, after pleading guilty in U.S. District Court in Miami to one count of conspiracy to commit healthcare fraud, DOJ and HHS said in a media release.

The trio worked at Metro Med of Hialeah Corp., a purported HIV infusion clinic that paid kickbacks to Medicare beneficiaries in exchange for the use of their Medicare identification numbers. From April 2003 through October 2005, Metro Med submitted $23 million in false claims related to the bogus treatments, of which Medicare paid $11.7 million, DOJ and HHS said.

Diaz instructed Metro Med owner Damaris Oliva which medications and in what amounts to bill Medicare to ensure a maximum reimbursement. Diaz, Aguilera and Rodriguez falsified patient files to indicate that the treatments were medically necessary. Aguilera and Rodriguez signed medical records falsely indicating that treatments were provided. Aguilera and Rodriguez also fabricated medical records to show that Metro Med patients had received specific dosages of medications. Aguilera manipulated patient blood samples to make it appear that unnecessary injection and infusion treatments were medically necessary, federal prosecutors said.

The trio was aware that beneficiaries were getting cash kickbacks in exchange for allowing Metro Med to bill Medicare using their ID numbers, DOJ and HHS said.

All three were charged in a July 2010 indictment, along with Oliva and Rene De Los Rios, MD. All five defendants now have pleaded guilty or been convicted. Oliva was sentenced in December to six years, eight months in prison. De Los Rios was convicted on April 14 of five felony counts by a federal jury for his role in the scam and will be sentenced on June 27, DOJ and HHS said.