December 6, 11

NEWS / Doctor and Two Nurses Sentenced to Prison for Roles in $25 Million Miami Health Care Fraud Scheme

WASHINGTON – Two nurses and a doctor were sentenced yesterday in Miami federal court for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).



The following defendants were sentenced by U.S. District Judge Joan A. Lenard in Miami:

Jose Nunez, 63, a medical doctor, was sentenced to 40 months in prison and was ordered to pay $1.1 million in restitution.
Luisa Morciego, 40, a registered nurse, was sentenced to ­­­24 months in prison and was ordered to pay $296,000 in restitution.
Eneida Fry, 46, a licensed practical nurse, was sentenced to 24 months in prison and was ordered to pay $395,000 in restitution.

Nunez, Morciego and Fry were also each sentenced to three years of supervised release. The defendants were ordered to pay restitution jointly and severally with the co-defendants in this case and in a separate but related Medicare fraud case.



Morciego, Nunez and Fry each pleaded guilty to one count of conspiracy to commit health care fraud.



According to plea documents, Nunez was a medical doctor at two Miami-area medical offices that he owned and operated. Nunez referred patients to ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. According to court documents, ABC and Florida Home Health billed the Medicare program for expensive physical therapy and home health services that were not medically necessary and/or never provided. Prescriptions, plans of care (POCs) and medical certifications for medically unnecessary therapy and services were issued through Nunez’s offices and other doctors’ offices in return for kickbacks and bribes. Nunez falsified patient files with descriptions of non-existent medical conditions, such as hand tremors, unsteady gait and poor vision, to make it appear that beneficiaries qualified for home health and therapy services.



From approximately January 2006 through March 2009, Nunez referred approximately 43 Medicare beneficiaries for medically unnecessary services to ABC and Florida Home Health. The medically unnecessary referrals, POCs and medical certifications resulted in approximately $1.5 million in fraudulent billings to Medicare, of which approximately $1.1 million was paid.



According to court documents, Morciego and Fry worked at ABC and Florida Home Health. Morciego and Fry, along with their co-defendant nurses, falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services, when, in fact, they did not. Morciego, Fry and their co-defendant nurses did so by, among other things, describing in the nursing notes and patient files symptoms that were nonexistent. Morciego and Fry knew that these files were falsified to bill Medicare for unnecessary services, which they knew was in violation of federal criminal laws.



Fry’s additional role in the scheme was to recruit Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Fry solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for allowing the agencies to bill Medicare on behalf of the recruited patients. Fry knew that the patients she recruited did not qualify for the services billed to Medicare and that their files were falsified to make it appear that they did qualify for the services.



As a result of Morciego’s and Fry’s participation in the illegal scheme, the Medicare program was billed approximately $296,000 and $395,000, respectively, for purported home health care services that were unnecessary and/or never provided.



The sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.



This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.



Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

http://www.justice.gov/opa/pr/2011/December/11-crm-1582.html

Tags: document,