May 5, 10

NEWS / Miami Clinic Consultant Convicted in $5.8 Million Fraudulent HIV Infusion Scheme

WASHINGTON – David Marrero, 49, was convicted today of health care fraud, conspiracy to commit money laundering and money laundering in connection with a $5.8 million Medicare fraud scheme relating to his involvement with a Miami-area HIV/AIDS infusion clinic, announced the Departments of Justice and Health and Human Services (HHS).

According to evidence at trial, in 2004, Marrero established Tendercare Medical Center Inc., with his then wife, listing himself as a “clinic consultant” on Tendercare’s Medicare application. In 2005, Tendercare began billing Medicare for expensive injection and infusion medications purportedly to treat HIV/AIDS-related blood disorders. Marrero recruited Medicare beneficiaries to come to Tendercare and hired Tendercare employees. The evidence at trial showed that these beneficiaries did not have the conditions listed in the Medicare billings for the clinic, and that the employees did not actually administer the treatments for which Medicare was billed. According to evidence presented at trial, between January 2005 and December 2007, Tendercare submitted approximately $5.8 million in false and fraudulent claims to Medicare for medically unnecessary injection and infusion treatments, most of which were not even provided. Medicare paid Tendercare approximately $2.7 million as a result of those fraudulent claims.

At trial, evidence showed that Marrero recruited his 76-year-old aunt to be a “patient” at Tendercare and reached an agreement with the then-owner of Tendercare to receive a portion of whatever Medicare paid Tendercare for billings under his aunt’s name. According to the bills submitted to Medicare, this woman was HIV positive, had multiple blood disorders, and during her first “treatment” received 100 units of medication for which Medicare was billed more than $10,000. In fact, as the evidence showed at trial, his aunt was not HIV positive and was not suffering from blood disorders. In addition, a Medicare representative testified that it was medically impossible to inject a patient with 100 units of this medication in a single office visit, which was the equivalent of an injection of approximately one liter of medication. According to the Medicare representative, there are now certain safeguards in place to prevent Medicare from paying clinics for this type of medically impossible bill.

At trial, a former employee of Tendercare testified that Marrero trained her on how to manipulate blood samples in order to generate a phony lab test that could be used to justify the company’s fraudulent billings. Evidence at trial also showed that Tendercare paid cash kickbacks to Medicare beneficiaries to induce them to participate in the scheme.

Following the verdict, Marrero was remanded into custody by U.S. District Court Judge Donald L. Graham of the Southern District of Florida. Sentencing for Marrero is currently scheduled for July 30, 2010, before U.S. District Judge Ursula Ungaro of the Southern District of Florida. Marrero faces a statutory maximum prison term of up to 10 years on each count for which he was convicted, in addition to a criminal fine of up to $250,000 or twice the gain or loss, whichever is greater.

Today’s guilty verdict was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division, U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida and Special Agent in Charge Christopher B. Dennis of the Miami Regional Office of the HHS Office of Inspector General (OIG).

The case was prosecuted by Assistant Chief John S. (Jay) Darden and Special Trial Attorney Martha Talley of the Criminal Division’s Fraud Section. The case was investigated by the FBI. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Florida and the Criminal Division’s Fraud Section.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 560 individuals who collectively have falsely billed the Medicare program for more than $1.2 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/2010/May/10-crm-526.html