Couple accused of leading $56 million Medicare fraud

[Judi Lynn]

Source: Miami Herald

Posted on Sat, May. 26, 2007
Couple accused of leading $56 million Medicare fraud
Federal prosecutors charged a couple with defrauding Medicare out of $56 million in one of the biggest healthcare fraud cases ever.
BY JOHN DORSCHNER
[e-mail]

In what was described as one of the biggest healthcare fraud cases ever in South Florida, federal prosecutors on Friday accused a couple of leading a billing company that bilked Medicare out of $56 million over a six-year stretch.
(snip)

''This is one of the most important cases ever filed by our office,'' U.S. Attorney R. Alexander Acosta said. ``This is our money which could have been used to treat patients rather than line the pockets of the accused.''

Prosecutors have been building their case since 2004, when they went into court to get a civil restraining order to stop the Diazes' company from continuing to bill Medicare because they had engaged in a ''massive, aggressive, avaricious Medicare fraud scheme,'' according to an agent's affidavit.
Starting in 1998, the indictment alleges, All-Med Billing Corp. used a series of durable medical equipment suppliers, many of which were open for only a few months, getting generally $1 million or $2 million each from Medicare and then folding before investigators charged the owners.
(snip)

Prosecutors are also requesting the criminal forfeiture of $32,292 in cash found in their home, funds in various bank accounts, their Miami Lakes home (valued at $307,000 according to county property records) and properties in Little Havana, Hialeah and Lehigh Acres.





Read more: http://www.miamiherald.com/884/story/119317.html

---

From the Sun-Sentinel:

Feds charge couple in fraud case

Staff report
Posted May 26 2007


Federal officials announced charges Friday against a Miami Lakes couple accused of submitting about $80 million in false Medicare claims for prosthetic limbs and other medical supplies that were never ordered by any doctor or delivered to any patient.

Mabel and Abner Diaz ran All-Med Billing Corp., a company that submitted Medicare claims on behalf of third parties. According to the 46-count indictment, the couple received about $56 million as a result of fraudulent billings between 1998 and 2004.

Mabel Diaz and an employee, Suleidy Cano, are accused of forging prescriptions for some of the medical equipment.

The government is seeking forfeiture of the couple's home, bank accounts and other property, including $32,292 and jewelry seized from their home in 2004.

http://www.sun-sentinel.com/news/local/palmbeach/sfl-pcfraud26may26,0,2110157.story?coll=sfla-news-palm

[izzie]

1. One wonders why they did not do all that work under the law.

I swear some people just like to make money this way when they have all this talent and could do such a good job in the real market. It is like trying to understand these unbelievable rich people who cheat on small amounts of money. Maybe it makes the blood flow or some such thing. I once knew a man who went on and on how he cheated the man he worked for out of money and it was not much but it seemed to really turn this guy on. I did get a laugh over it as my father was in the same business this man was cheating and these business men knew it and wrote it off as how they had to do business. Petty crooks. As my father used to say you can put some peoples worth on a 10 dollar bill he is willing to steal. Cheating old sick people seems right in line for cheats like this. I have read that medicare is run much better than the private companies. The top people seem to be getting the big money in that field.

[fasttense]

2. When the pResident of the United States is ignoring laws

and the pResident of Vice is bilking billion from no bid contracts what's a little Medicare fraud. When the standard is set so low by the richest, most privileged and powerful among us, is it any wonder others ignore the law too.

[lonestarnot]

6. Ain't it a bitch! So many getting away with ignoring law these days.

[Doctor_J]

3. That's what Halliburton defrauds us of EVERY 40 min or so

just in Iraq. Diaz & Cano should just change their mailing address to Dubai.

[Scurrilous]

4. Joint investigation reveals $101 million fraud scheme against Medicare

News Releases

May 25, 2007


R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, special agent in charge, Federal Bureau of Investigation, Miami Field Office, Melody Jackson, special agent in charge, United States Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office, Anthony Mangione, special agent in charge, U.S. Immigration and Customs Enforcement, and Bill McCollum, Attorney General, State of Florida, today announced criminal health care fraud charges against 16 defendants for fraudulently billing Medicare approximately $101 million.

On May 22, 2007, a Miami federal grand jury returned a 46-count indictment against eight defendants. The indictment charges Mabel and Abner Diaz, wife and husband, with operating All-Med Billing Corp. (All-Med), a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment (DME) and related services. The indictment alleges that All-Med submitted approximately $80 million in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient. As a result of the submission of the fraudulent claims, Medicare paid the DME companies approximately $56 million. The indictment also seeks forfeiture of the fraud proceeds and substitute assets, including real estate of the Diazes.

Also charged in the All-Med billing fraud scheme was All-Med employee Suleidy Cano. The Diazes were additionally charged with conspiracy to launder the proceeds of the alleged All-Med billing fraud scheme. Other defendants charged are Amry Garcia, Davel Hernandez, and Rene Raimundo Hernandez. They are charged with conspiring to defraud Medicare in their operation of A-1 Durable Medical Equipment and Supplies, Inc. (A-1), a Miami DME company. According to the Indictment, A-1 received approximately $2.1 million in response to fraudulent claims that were submitted to Medicare by All-Med.

The indictment also charges defendants Jose Luis Palma, Jr. and Luis Gonzalez withconspiracy and Medicare fraud in connection with the operation of Simply Medical Services, Inc. (Simply Medical), a Miami DME company. Gonzalez was also charged with Medicare fraud in relation to another DME company, Premier Medical Service. Inc. As a result of fraudulent claims alleged to have been submitted by All-Med on behalf of Simply Medical and Premier, Medicare paid over $3.7 million.

If convicted of the conspiracy and health care fraud charges, each of the eight defendants faces a maximum punishment of 10 years’ imprisonment per count. The Diazes face an additional 20 years’ imprisonment on the money laundering charge.

On a separate indictment, defendants Jose Tomas Iglesias, Marco Antonio Marrero, and Leslie Gonzalez were charged with conspiring to defraud Medicare in connection with the fraudulent submission of $6.8 million in DME-related claims during 2006. The claims concerned a Miami DME company named Bridge Medical Equipment, Inc. Medicare paid Bridge approximately $1 million in response to the bogus claims, which were for DME items that were neither prescribed by doctors nor delivered to Medicare patients.

Iglesias was also separately charged with several counts of illegally laundering the fraud proceeds through the cashing or depositing of various checks and with aggravated identity theft by using another’s Florida driver’s license in connection with the health care fraud scheme.

If convicted, the three defendants face 10 years’ imprisonment on the health care fraud charges. Iglesias faces up to 20 years’ imprisonment on each of the money laundering charges. Finally, Iglesias faces a mandatory consecutive two-year prison term on the aggravated identity theft charge.

Other indictments and guilty pleas related to the investigation:

On May 22, 2007, defendant Alejandro De La Victoria, the owner of Precise Medical Services, Inc., a Miami DME company, was indicted, Case No. 07-20397-Cr-Gold, on fraud charges for submitting approximately $3 million in fraudulent DME claims to Medicare during several months in 2006, and receiving approximately $1.4 million in payments. De La Victoria faces up to 10 years in prison on each of the six health care fraud charges.

On May 15, 2007, defendant Maria Oliveros-Garay was indicted on four counts of health care fraud in connection with a Medicare billing fraud involving Abue Medical Equipment, Inc., a Miami DME company. According to the Indictment, Case No. 07-20377-Cr-Cooke, Oliveros-Garay submitted approximately $3.8 million in fraudulent DME-related claims to Medicare in 2006, of which Medicare paid approximately $1.5 million. If convicted, Oliveros-Garay faces up to 10 years imprisonment on each count.

On May 23, 2007, the U.S. Attorney’s Office filed two separate informations against two individuals in separate DME-related fraud cases. In one case, Case No. 07-20405-Cr-Martinez,defendant Mario Mira was charged with one count of health care fraud in connection with Mario & Clara Medical Supply, Inc., of Miami, a DME company that submitted at least $2.5 million in fraudulent DME claims to Medicare in 2006. Mira faces a maximum term of imprisonment of 10 years.

In the second case, Case No. 07-20406-Cr-Jordan, defendant Eduardo Ruiz was charged with one count of health care fraud in connection with EZ Medical, Inc., a Tampa DME company. According to the Information, Ruiz caused the submission of approximately $5.3 million in fraudulent DME claims in 2005 by misappropriating and using the Medicare identification numbers of Miami-Dade beneficiaries. Medicare paid approximately $1.38 million on these claims. Ruiz faces a maximum prison term of 10 years.

On May 24, 2007, defendant Eredio Prieto pled guilty in Case No. 07-20333-Cr-Huck, to one count of money laundering. The charge arose out of Prieto’s use of a shell corporation, Royalty Group Investment Corp. (Royalty Group). According to court records, Prieto deposited proceeds of health care fraud, involving South Florida health care companies, into Royalty Group bank accounts and then engaged in financial transactions to launder approximately $147,000 in Medicare funds in 2006. Prieto faces a maximum of 20 years’ imprisonment. Sentencing is scheduled for August 22, 2007.

Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation, the United States Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office, the U.S. Immigration and Customs Enforcement, Miami, and Office of the Florida Attorney General. Assistant U.S. Attorneys Marc Osborne, David Frank, Luis M. Pérez, and Jeffrey Marcus are prosecuting these cases.

http://www.ice.gov/pi/news/newsreleases/articles/070525miami1.htm

[Turbineguy]

5. U.S. Attorney R. Alexander Acosta

Let's hope he doesn't get fired first.

[Judi Lynn]

7. Jeb Bush's Cuban

Quite the achievement, wasn't it? _{Jeb Bush} apparently assisted him enormously:

Bush Family Value$

News: The Bush clan's family business

By Stephen Pizzo

September 1, 1992

......

Jeb and Miguel Recarey

~snip~
IMC was run by Cuban-American Miguel Recarey, a character with a host of idiosyncrasies. He carried a 9-mm Heckler & Koch semiautomatic pistol under his suit coat and kept a small arsenal of AR-15 and Uzi assault rifles at his Miami estate, where his bedroom was protected by bullet-proof windows and a steel door. It apparently wasn't his enemies Recarey feared so much as his friends. He had a long-standing relationship with Miami Mafia godfather Santo Trafficante, Jr., and had participated in the illfated, CIA-inspired mob assassination plot against Fidel Castro in the early 1960s. (Associates of Recarey add that Trafficante was the money behind Recarey's business ventures.)

Recarey's brother, Jorge, also had ties to the CIA. So it was no surprise that IMC crawled with former spooks. Employee résumés were studded with references to the CIA, the Defense Intelligence Agency, and the Cuban Intelligence agency; there was even a fellow who claimed to have been a KGB agent, An agent with the U.S. Office of Labor Racketeering in Miami would later describe IMC as a company in which "a criminal enterprise interfaced with intelligence operations."

Recarey also surrounded himself with those who could influence the political system. He hired Jeb Bush as IMC's "real-estate consultant." Though Jeb would never close a single real-estate deal, his contract called for him to earn up to $250,000 (he actually received $75,000). Jeb's real value to Recarey was not in real estate but in his help in facilitating the largest HMO Medicare fraud in U.S. history.

Jeb phoned top Health and Human Services officials in Washington in 1985 to lobby for a special exemption from HHS rules for IMC. This highly unusual waiver was critical to Recarey's scam. Without it, the company would have been limited to a Medicare patient load of 50 percent. The balance of IMC's patients would have had to be private -- that is, paying -- customers. Recarey preferred the steady flow of federal Medicare money to the thought of actually running a real HMO. Former HHS chief of staff McClain Haddow (who later became a paid consultant to IMC) testified in 1987 Jeb that directly phoned then-HHS secretary Margaret Heckler and that it was that call that swung the decision to approve IMCs waiver.

Jeb admits lobbying HHS for the waiver, but denies talking to Secretary Heckler -- and denies as well the charge that his call won the HHS exemption. "I just asked that IMC get a fair hearing," said later. After the IMC scandal broke in 1987, Heckler left the country, having been appointed U.S. ambassador to Ireland, a post she held until 1989. (Heckler is now a private citizen living in Virginia. We left a detailed message with her secretary, outlining our questions, but she declined to respond.)
(snip)

http://www.motherjones.com/news/feature/1992/09/bushboys.html

On edit, adding Miguel Recarey information:

~snip~
Beginning with John "Jeb" Bush, now governor of Florida, we find that he assisted Miguel Recarey, a fugitive now living in Spain, to steal over $200 million from International Medical Centers, the HMO Recarey owned, by using Jeb's father's influence to acquire a waiver for the HMO of the standard rule of 50-50 (meaning that at least 50% of an HMO's clients cannot be Medicare patients but must be full paying clients). This theft left 150,000 elderly Americans without medical coverage. Oh, and by the way, Recarey had paid Jeb Bush's company a $75,000 "real-estate consultant fee". All totaled, Recarey embezzled over $1 billion in Medicare funds through false billings and outright theft.
(snip)

http://www.anotherperspective.org/advoc296.html

[Judi Lynn]

8. Sorry about the subject line. Got distracted, dammit, and didn't notice it was unfinished.

I was attempting to post _{Jeb Bush's} Cuban exile associate, Miguel Recarey, pulled of the largest Medicare fraud in history.

Sheesh!

Sorry.

[SharonAnn]

10. When I read the original post describing where and what it was, I figured it was a

Right-wing, Republican, anti-Castro Cuban. One of the "entitled ones" who thinks they should take Cuba back and rape it some more.

Sigh.

I hate stereotyping and here I found myself doing it automatically.

Then I read further and found out that my supposition was true.

Are there any anti-Castro Cubans who want real Democracy in Cuba? The only ones I've met, if they're fervid anti-Castro believers, are the ones who really want Cuba to return to an oligarchy and they want to be the oligarchs.

[Blue_Tires]

9. that's why they are going to look back on these days as

the 'enron generation'....if you ain't cheatin', you ain't tryin'