WASHINGTON–(ENEWSPF)–October 29, 2012. Two owners of Miami area assisted living facilities (ALF) pleaded guilty on Friday in connection with a health care fraud scheme involving defunct Miami area health provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
Raymond Rivero, 55, of Homestead, Fla., and Ivon Perez, 50, of Miami, each pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to solicit and receive cash kickbacks. Rivero, who was the owner of Miami-based God Is First ALF, and Perez, who was the owner of Kayleen and Denis Care Corp, admitted to participating in a fraud scheme that was orchestrated by the owners and operators of HCSN, which operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness.
Earlier this week, the owner of another ALF in the Miami area that was involved in the HCSN fraud scheme pleaded guilty for his role in the scheme. On Oct. 22, 2012, Daniel Martinez, 45, of Homestead, the owner of Mi Renacer ALF, pleaded guilty before Judge Altonaga to one count of soliciting and receiving cash kickbacks.
According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided. HCSN obtained those beneficiaries by paying kickbacks to owners and operators of ALFs or by otherwise recruiting them from ALFs and nursing homes. Rivero, Martinez and Perez pleaded guilty to referring Medicare and/or Florida Medicaid beneficiaries to HCSN in exchange for cash bribes.
According to court documents, ALF residents referred by Rivero, Martinez and Perez were not qualified to be placed in HCSN’s PHP and were only selected because they had Medicare or state of Florida Medicaid benefits. In some cases, ALF patients suffered from dementia, Alzheimer’s disease or mental retardation or were otherwise unable to benefit from the purported mental health services.
According to court documents, from 2004 through 2011, HCSN billed Medicare and Medicaid approximately $63 million for purported mental health services.
Perez also pleaded guilty before Judge Altonaga in another criminal case to a second count of conspiracy in connection with accepting kickbacks from Superstar Home Health Care Inc. for purported home health services to her ALF residents.
In another related case, a former HCSN employee, Sarah Da Silva Keller, 28, was sentenced by U.S. District Judge Marcia G. Cooke in the Southern District of Florida to a 24 month prison term and ordered to pay $1,067,300 in restitution to the Medicare program. In June 2012, Keller pleaded guilty to an information charging one count of conspiracy to commit health care fraud.
According to court documents, Keller falsified patient attendance and medical records for Medicare beneficiaries who attended HCSN for mental health treatment. The falsified records were then utilized to submit fraudulent billing to the Medicare program. According to Keller’s plea agreement, Keller’s participation in the fraud resulted in more than $2.4 million in fraudulent billing to the Medicare program.
The cases are being prosecuted by Special Trial Attorney William Parente and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section. The Superstar Home Health case is being prosecuted by Assistant U.S. Attorney Eric Morales of U.S. Attorney’s Office for the Southern District of Florida. These cases were investigated by the FBI and HHS-OIG and were 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 Florida.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is 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.