June 9, 09

NEWS / Four Miami-Area Residents Sentenced in $10 Million Medicare Fraud Scheme Defendants Admitted to Cons

WASHINGTON—Four Miami-area residents were sentenced today in connection with a $10 million Medicare fraud scheme involving HIV infusion clinics, Assistant Attorney General Lanny A. Breuer of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced.

Alexis Dagnesses, 44; Gonzalo Nodarse, 38; Alexis Carrazana, 41; and Dr. Carlos Garrido, 69, all pleaded guilty in March 2009 to one count of conspiracy to commit health care fraud before U.S. District Judge Paul C. Huck.

Today, Judge Huck sentenced Dagnesses to 90 months in prison, to be followed by a three-year-term of supervised release. Dagnesses was also ordered to pay $12.4 million in restitution. Nodarse was sentenced to 78 months in prison, with a three-year-term of supervised release following his prison term, and was ordered to pay $5.1 million in restitution. Carrazana was sentenced to 72 months in prison, to be followed by three years of supervised release, and was ordered to pay $3.6 million in restitution. Garrido was sentenced today to 37 months in prison and three years of supervised release, and was ordered by the judge to pay $747,000 in restitution.

All four defendants had admitted to working at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of patients with HIV. According to plea documents, most of the services allegedly provided to patients at Midway were billed to the Medicare program as treatments for a diagnosis of thrombocytopenia, a disorder involving a low count of platelets in the blood. None of Midway’s patients actually had low blood platelet counts.

Dagnesses’ admitted role at Midway was to manipulate the blood samples drawn from the clinic’s patients before the blood was sent to a laboratory for analysis, so that the resulting laboratory reports would make it appear that the patients actually had dangerously low blood platelet counts. Specifically, Dagnesses would obtain vials of blood drawn from Midway’s patients and place those vials in a blood centrifuge. After rotating the blood in the centrifuge for approximately 15 minutes, the blood would separate into its component parts, enabling Dagnesses to extract the platelets from the sample. Dagnesses would then return the adulterated blood to his co-conspirators at Midway, who would send it to a laboratory for testing.

Dagnesses admitted he was generally paid $1,000 for every vial of blood that he tainted for his co-conspirators at Midway. Dagnesses also admitted he was fully aware that the purpose of tainting the blood was to obtain false laboratory reports for Midway’s medical files, which would make it appear that the medications allegedly provided at Midway were medically necessary, when in fact they were not. At today’s sentencing, Dagnesses was found to have engaged in similar conduct at two additional fraudulent HIV infusion clinics, and he was held accountable for conspiring to cause the submission of more than $20 million in fraudulent claims at the three clinics.

Nodarse and Carrazana worked at Midway as medical assistants. In their pleas, the two defendants admitted to making false entries in medical records that indicated they had provided medications on particular dates and in particular dosages to patients, when, in fact, they had not. The two also admitted to being fully aware that blood samples drawn from Midway’s patients were tainted to make it appear that the patients had conditions they did not have. Despite this awareness, both assistants admitted to administering medications to patients that they knew the patients did not need. Both defendants were found to have conspired to submit more than $10 million in false and fraudulent claims for HIV infusion services allegedly provided at the clinic.

Garrido was a part-owner and practicing physician at Midway. In his plea, Garrido admitted that he and his co-conspirators billed the Medicare program routinely for services that were medically unnecessary and in many instances were never provided. Garrido admitted to purchasing only a small fraction of the medication that was purportedly being administered to Midway’s patients, and that he ordered the patients treated with medications he knew they did not need and, in many instances, the clinic did not have available. Garrido also admitted to working at Midway for approximately eight months (the last eight months the clinic was open). In that time, he admitted to submitting more than $1 million in fraudulent claims to the Medicare program.

Two additional co-conspirators, Doctors Carmen Lourdes del Cueto and Roberto Rodriguez, also pleaded guilty in March 2009 to conspiring to commit health care fraud at Midway. Rodriguez’s sentencing is scheduled for June 29, 2009, and Del Cueto’s has been scheduled for Sept. 11, 2009.

The case is being prosecuted by Trial Attorney John K. Neal of the Criminal Division’s Fraud Section. The FBI and the Department of Health and Human Services - Office of Inspector General conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Federal prosecutors have indicted 108 cases with 196 defendants in strike force operations since investigations opened in March 2007. Collectively, these defendants fraudulently billed the Medicare program for more than $577 million.

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