June 30, 09

NEWS / Miami Physician Sentenced to 97 Months in Prison for Role in $10 Million Medicare Fraud Scheme

WASHINGTON—Miami physician Roberto Rodriguez, 54, was sentenced today to 97 months in prison for his role in a Medicare fraud scheme involving HIV infusion services, announced Assistant Attorney General Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H. Sloman of the Southern District of Florida and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS). Rodriguez was also ordered to pay more than $9 million in restitution to the Medicare program during today’s sentencing hearing before U.S. District Judge Paul C. Huck.

Rodriguez pleaded guilty before Judge Huck on March 23, 2009, to conspiracy to commit healthcare fraud. In his guilty plea, Rodriguez admitted that he was a co-owner of and practicing physician at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of HIV patients. Rodriguez admitted that, while at Midway, he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and in many instances were never provided. Rodriguez further admitted that he purchased only a small fraction of the drugs that were purportedly administered to patients at the clinic.

Most of the services allegedly provided to patients at Midway were billed to the Medicare program as treatments for thrombocytopenia, a disorder involving a low count of platelets in the blood. According to the plea documents, none of Midway’s patients actually had low blood platelet counts. Rodriguez admitted that to make it appear that the patients actually had low platelet levels, he and his co-conspirators used chemists to manipulate the blood samples drawn from Midway’s patients before the blood was sent to a laboratory for analysis. In his plea, Rodriguez admitted to ordering that patients at Midway receive medications designed to treat thrombocytopenia despite knowing that the laboratory results had been falsified and that the patients did not actually have that condition.

Midway was not the only clinic where Rodriguez purported to treat HIV patients with injection and infusion therapies. In his plea, Rodriguez admitted that he was listed as medical director and practicing physician for five other Miami-area HIV infusion clinics between October 2003 and February 2005, where he engaged in similar criminal activity. Specifically, Rodriguez admitted that he and his co-conspirators at these other clinics billed the Medicare program for HIV injection and infusion services that Rodriguez knew were medically unnecessary and in some instances were never provided. Rodriguez admitted to causing more than $20 million in false claims to be submitted to the Medicare program at all of his clinics, including Midway.

A number of Rodriguez’s co-defendants have already been sentenced for their roles at Midway and related clinics. On June 5, 2009, in a sentencing hearing before Judge Huck, chemist Alexis Dagnesses, 44, was sentenced to 90 months in prison; medical assistant Gonzalo Nodarse, 38, was sentenced to 78 months in prison; medical assistant Alexis Carrazana, 41, was sentenced to 72 months in prison; and physician Carlos Garrido, 69, was sentenced to 37 months in prison. Rodriguez’s co-defendant Carmen del Cueto, a physician, is scheduled to be sentenced on Sept. 11, 2009.

The case was prosecuted by Trial Attorney John K. Neal of the Criminal Division’s Fraud Section and investigated by the HHS Office of the Inspector General and the FBI. The case was brought as part of the Medicare Fraud Strike Force, supervised by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section and Acting U.S. Attorney Sloman of the Southern District of Florida. Federal prosecutors have indicted 115 cases with 257 defendants in Miami, Los Angeles and Detroit since the inception of strike force operations in March 2007. Collectively, these defendants are alleged to have fraudulently billed the Medicare program for more than $600 million.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. In May 2009, the Department of Justice and HHS announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort to prevent fraud and enforce current anti-fraud laws around the country. As part of the HEAT initiative, Medicare Fraud Strike Force operations were expanded from South Florida and Los Angeles to Detroit and Houston. To learn more about the HEAT initiative, go to: www.hhs.gov/stopmedicarefraud .

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