February 7, 11

NEWS / Eight Miami-Area Nurses Sentenced to Prison for $18.7 Million Medicare Fraud Scheme Involving Home H

WASHINGTON – Eight Miami-area nurses were sentenced to prison today for their roles in an $18.7 million Medicare fraud scheme involving home health care, announced the Departments of Justice and Health and Human Services.



The eight individuals each previously pleaded guilty to one count of conspiracy to commit health care fraud and were sentenced by U.S. District Court Judge Ursula Ungaro in Miami as follows:



· Diana Sanabia, 36, registered nurse (R.N.), was sentenced to 30 months in prison, three years of supervised release and ordered to pay $594,000 in restitution;

· Daisy Santos, 43, R.N., was sentenced to 30 months in prison, three years of supervised release and ordered to pay $699,000 in restitution;

· Roberto Rodriguez, 44, R.N., was sentenced to 30 months in prison, three years of supervised release and ordered to pay $603,900 in restitution;

· Marlene Magadan, 36, R.N., was sentenced to 24 months in prison, three years of supervised release and ordered to pay $334,200 in restitution;

· Maria Perez, 49, R.N., was sentenced to 18 months in prison, three years of supervised release and ordered to pay $180,600 in restitution;

· Alberto Alvarez, 55, R.N., was sentenced to 15 months in prison, three years of supervised release and ordered to pay $101,800;

· Yanisley Chao, 32, licensed practical nurse (L.P.N.), was sentenced to 5 months in prison, two years of supervised release and ordered to pay $66,800 in restitution; and

· Leonardo Malagon, 40, L.P.N., was sentenced to 5 months in prison, two years of supervised release and ordered to pay $65,900 in restitution.



The nurses were originally charged in a July 2010 indictment. Jorge Dieppa, M.D., who is also charged in the July 2010 indictment, awaits trial on one count of conspiracy to commit health care fraud and one count of false statements related to rights for benefit and payment by Medicare. The indictment also seeks forfeiture.



According to court documents, Miami-based health care agencies ABC Home Health Inc. and Florida Home Health Care Providers Inc. were owned by co-conspirators. ABC and Florida Home Health purported to provide home health and therapy services to Medicare beneficiaries. In particular, ABC and Florida Home Health referred Medicare beneficiaries to Dieppa to obtain prescriptions, medical certifications and plans of care for therapy and home health services at ABC and Florida Home Health. As a result, Medicare was billed approximately $18.7 million for services that were medically unnecessary and/or never provided.



According to plea documents, Perez and Chao worked for Florida Home Health; Santos, Magadan and Malagon worked for ABC; and Sanabia, Rodriguez and Alvarez worked for both ABC and Florida Home Health. These defendants falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for services from Florida Home Health or ABC that were prescribed by Dieppa. In fact, the defendants knew that the services were not medically necessary and /or were not rendered.



According to plea documents, Sanabia and Santos also recruited Medicare beneficiaries for the agencies and received kickbacks for the recruitments. Sanabia and Santos knew that the beneficiaries they recruited did not qualify for the home health services for which ABC and Florida Home Health billed Medicare.



Co-defendant Alfredo Zayas, 76, a Medicare beneficiary who pleaded guilty to one count of conspiracy to commit health care fraud, was also sentenced today by Judge Ungaro to two years of probation. According to plea documents, Zayas, a beneficiary, solicited and accepted kickbacks and bribes for allowing his Medicare number to be used to bill Medicare for unnecessary home health treatments.



Sanabia, Santos, Magadan, Perez, Rodriguez, Alvarez, Chao, Malagon and Zayas were responsible for fraudulently billing to Medicare the following approximate amounts, respectively: $594,000, $699,000, $381,100, $180,600, $603,900, $101,800, $66,800, $65,900 and $23,800.



The sentences were announced by Assistant Attorney General Lanny A. Breuer of the 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 Miami.



Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 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.



To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov .

http://www.justice.gov/opa/pr/2011/February/11-crm-154.html

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