September 16, 10

NEWS / Miami Home Health Patient Recruiter Convicted of Conspiracy

To Commit Health Care Fraud and Soliciting and Receiving Kickbacks

WASHINGTON – Antonio Ochoa, a patient recruiter for Miami home health agencies, was convicted today by a federal jury in Miami of one count of conspiracy to commit health care fraud and of three counts of soliciting and receiving kickbacks and bribes, announced the Departments of Justice and Health and Human Services (HHS).

According to evidence at trial, Ochoa was a patient recruiter and home health aide for ABC Home Health Inc. and Florida Home Health Care Providers Inc. ABC and Florida Home Health purported to provide physical therapy and home health services to Medicare beneficiaries. Evidence at trial established that Ochoa solicited and received tens of thousands of dollars in checks and cash payments as kickbacks and bribes in exchange for referring Medicare beneficiaries to ABC and Florida Home Health.

According to evidence and testimony presented at trial, Ochoa and his co-defendant Eduardo Romeo acted as partners in the recruiting scheme and received kickbacks and bribes of approximately $1300 per Medicare beneficiary from the owners of ABC and Florida Home Health. The home health agencies then billed the Medicare program on behalf of the Medicare beneficiaries Ochoa and Romeo recruited. Evidence at trial established that ABC and Florida Home Health billed the Medicare program for services that were medically unnecessary and often never provided, such as twice daily nursing visits for diabetic insulin injections, home health aide visits and therapy for the beneficiaries. Romero pleaded guilty to conspiracy to commit health care fraud and kickback charges in July 2010. He testified at trial.

According to trial testimony, Ochoa and Romero would also solicit their co-defendant Francisco Portillo, a nurse who testified at trial, to pay them kickbacks and bribes in return for ensuring that Portillo would be assigned by ABC and Florida Home Health as the nurse for the beneficiaries they recruited. Evidence showed that Portillo was paid by the agencies for each patient to which he was assigned. Portillo testified that he would falsify nursing notes to make it appear that the recruited patients needed and qualified for the home health services, even though they did not, and in many instances Portillo did not even provide the services. Portillo, who pleaded guilty one count of conspiracy to commit health care fraud and one count of making false statements in patient files, also testified that one of the patients recruited by Ochoa and Romero wasn’t even an insulin-dependant diabetic.

According to evidence at trial, Ochoa knew that the patients did not qualify for and did not need the services. Portillo testified that the patient files for the beneficiaries Ochoa recruited were falsified to make it appear that they qualified for home health care and therapy services and so that the Medicare program could be billed for the services.

At sentencing, Ochoa faces a maximum of 10 years in prison for the conspiracy to commit health care fraud count, and five years in prison as to each of the three kickback counts.

Also charged in the case were Dr. Fred Dweck; Yudel Cayro and Arturo Fonseca, owners of Courtesy Medical Group, where Dr. Dweck worked; nurses Isis Torres, Francisco Portillo, Teresita Leal, Armando Sanchez, Sheillah Rotta, Silvio Ruiz, Lissbet Diaz, Marlenys Fernandez, Alain Fernandez; and Medicare beneficiary William Madrigal.

Dr. Dweck admitted to issuing prescriptions, plans of care and medical certifications for unnecessary home health care and therapy services for over 848 Medicare beneficiaries. As a result of Dr. Dweck’s referrals, of which approximately 344 were through Courtesy Clinic, various Miami-area home health agencies billed the Medicare program for more than $37 million in false and fraudulent claims. Dr. Dweck pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patients files; Cayro pleaded guilty to one count of conspiracy to commit health care fraud; Fonseca pleaded guilty to one count of conspiracy to commit health care fraud and several counts of receiving kickbacks; and each of the nurses pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patient files. Each of the defendants in the case will be sentenced before U.S. District Judge Adalberto Jordan in U.S. District Court in Miami later this year.

The conviction was 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.

The case was prosecuted by Trial Attorneys N. Nathan Dimock, Sam Sheldon and Henry Van Dyck of the Criminal Division’s Fraud Section, with assistance of the Miami U.S. Attorney’s office. This case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals who collectively have falsely billed the Medicare program for more than $1.85 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/September/10-crm-1033.html