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The Miami Herald
Feds make Medicare fraud sweeps in Miami, nationwide
By JAY WEAVER
February 18, 2011

Miami lived up to its billing as the nation’s Medicare fraud capital on Thursday when authorities announced they charged more than 100 doctors, nurses and executives nationwide with conspiring to loot $225 million from the federal health insurance program.

About one-third of the 111 people charged were from Miami.

The takedown here and in eight other cities was touted by the Obama administration as the largest number of healthcare fraud arrests in U.S. history.

The coordinated announcement of numerous indictments at press conferences in Miami and Washington aimed to boost awareness that the government is striving to go after people who steal from the taxpayer-funded healthcare program, which bleeds billions each year because of rampant fraud. The Justice Department’s Medicare strike forces, launched in Miami in 2007, have now been franchised in eight other U.S. cities.

“As a prosecutor and a South Floridian, this is outrageous,” said U.S. Attorney Wifredo Ferrer. “When you defraud Medicare, you’re stealing taxpayers’ hard-earned money that is intended for the ill and the elderly.”

Thursday’s nationwide sweep surpassed a similar takedown of 94 Medicare fraud defendants in July. But the FBI’s top agent in South Florida said arresting people who rip off Medicare is not the sole solution to the crisis, suggesting that U.S. Department of Health and Human Services regulators should be more aggressive against suspicious healthcare providers.

Special Agent in Charge John Gillies said Medicare should conduct comprehensive criminal background checks on providers, stop the practice of paying claims within 14 days, suspend payments for questionable charges, and change the system of using Social Security numbers for beneficiaries to prevent identity theft.

“Miami remains ground zero for healthcare fraud,” Gillies said at the U.S. attorney’s office press conference. “The current honor system is not working. We all pay until changes are made.”

The Miami indictments, along with others filed around the country, revolved around medical equipment, physical therapy, home healthcare and prescription drug scams. The dozen indictments allege that 32 defendants plotted to bilk more than $50 million from the Medicare program in recent years.

The most significant case in Miami revolves around two agencies, ABC Home Health Care, 8360 W. Flagler St., and Florida Home Health Care Providers, 4150 NW Seventh St., which submitted a combined $25 million in bogus bills to healthcare for unnecessary diabetic services, physical therapy and other treatments. The case, which has already generated convictions of the business owners, doctors and nurses on charges ranging from fraud to kickbacks, expanded dramatically on Thursday.

Among the 21 Miami-Dade defendants in the case: Dr. Jose Nunez and Dr. Francisco Gonzalez, accused of writing prescriptions for homebound diabetic patients and receiving kickback as payments for their services.

Also charged in the indictment: Nurses Eneida Fry, Jorge Pineiro, Maritza Vidal, Ignacio Angulo, Farah Maria-Perez and Odalys Alvarez-Medina. They’re accused along with others of receiving kickbacks for recruiting patients into the alleged homecare referral scheme.

Thursday’s arrests by agents with Health and Human Services, Office of Inspector General and the FBI followed Tuesday’s takedown of 20 other South Florida defendants charged in a widening investigation of a Miami-based mental health clinic.

The defendants included a trio of local doctors – psychiatrists Mark Willner, Alan Gumer and Alberto Ayala — who approved group therapy for thousands of patients at American Therapeutic Corp., which had been indicted along with its four top executives in October on charges of submitting $200 million in bogus bills to Medicare since 2007. The seven-clinic chain was paid $83 million for unnecessary counseling, according to the Justice Department.