Miami-Area Therapist Sentenced to Prison in Florida in $205 Million Community Mental Health Fraud Scheme

WASHINGTON—Miami-area resident Nichole Eckert, former therapist at the mental health care company American Therapeutic Corporation (ATC), was sentenced today to serve 48 months in prison for participating in a $205 million Medicare fraud scheme.
The sentence was announced today by 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; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the Health and Human Services’ Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.
Eckert, 35, was sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. In addition to the prison term, Judge Seitz sentenced Eckert to serve three years of supervised release and ordered her to pay more than $72 million in restitution, jointly and severally with her co-defendants.
On November 15, 2012, a federal jury in the Southern District of Florida found Eckert guilty of one count of conspiracy to commit health care fraud after a 16-day trial. She has been in federal custody since her conviction.
Evidence at trial demonstrated that the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. The defendant and her co-conspirators also used a related company, American Sleep Institute, to submit fraudulent Medicare claims.
Evidence at trial revealed that ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC. These patients attended ATC, where they were ineligible for the treatment ATC billed to Medicare and where they did not receive the treatment that was billed to Medicare. After Medicare paid the claims, some of the co-conspirators then laundered the Medicare money in order to create cash to pay the patient kickbacks.
Eckert was a therapist at ATC’s Ft. Lauderdale, Florida center from September 2005 to September 2007 and returned to ATC as a therapist from late 2009 to October 2010, when ATC closed its doors as a result of federal charges. Evidence at trial revealed that Eckert fabricated therapist notes and other documents for patient files and submissions, and taught others to fabricate them, to make it appear both that ATC patients were qualified for PHP treatment and that they were receiving the intensive, individualized treatment PHP is supposed to be. ATC used those patient files to substantiate false and fraudulent claims to Medicare. Included in these submissions were claims for patients who were in the late stages of diseases causing permanent cognitive memory loss and patients who had substance abuse issues and were living in halfway houses. These patients were ineligible for PHP treatments, and because they were forced by their assisted living facility owners and halfway house owners to attend ATC, they were not receiving treatment for the diseases they actually had.
ATC and related company Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. On September 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010. Dozens of individuals have been convicted at trial or pleaded guilty for their participation in the scheme.
Evidence at trial showed that the ATC scheme resulted in a total of $205 million in fraudulent Medicare billings.
The cases were prosecuted by Senior Trial Attorney Jennifer L. Saulino and Trial Attorney Laura M.K. Cordova of the Justice Department Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and was 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.

Another Orthofix Defendant Sentenced for Committing Medicare Fraud

BOSTON—A former Orthofix territory manager was sentenced yesterday for defrauding Medicare by forging patient medical records.
Michael J. McKay, 32, was sentenced by U.S. District Court Judge Denise J. Casper to one year of probation, with the first three months to be served in home confinement, and ordered to forfeit $10,000 and pay a fine of $3,000. In May 2012, McKay pleaded guilty to health care fraud.
Between 2008 and 2009, McKay was a territory manager for Orthofix, a company that manufactured and distributed bone growth stimulator medical devices that were intended to assist patients with bone fractures that did not heal properly. Medicare and many private insurance carriers have specific guidelines describing when it will pay for bone growth stimulators. When McKay received orders for patients that did not satisfy these guidelines, McKay frequently falsified the patients’ medical records to make it appear as though the order met Medicare’s rules so that Medicare would pay for a claim that otherwise would not be covered. Between 2008 and 2010, federal insurance carriers paid more than $70,000 for bone growth stimulators for claims where McKay falsified medical records. McKay altered physicians’ charts notes, changing the dates of patient visits, describing patient visits that did not occur, and inserting false diagnoses. McKay also forged prescriptions and Medicare Certificates of Medical Necessity within the orders. Orthofix fired McKay after it discovered his fraud. Even after he was fired, however, McKay continued to submit orders for stimulators by submitting them to a colleague, Derrick Field, who split the commissions with Field. Even after he was fired, McKay continued to forge chart notes, prescriptions, and CMNs in the orders he submitted to Field. On January 9, 2013, Field was sentenced to five months home confinement, two years of probation, and $44,000 in fines and forfeiture.
In addition to the McKay sentence, the Orthofix investigation has to date resulted in a number of felony charges against employees and contractors of Orthofix, including the following:
In December 2012, Orthofix was convicted of obstruction of a federal audit and ordered to pay $42 million in criminal fines and civil payments and was sentenced to probation for five years.
On January 22, 2013, Tom Guerrieri, the former vice president of sales for Orthofix, was sentenced to eight months in prison and ordered to pay $50,000 in fines and forfeiture for paying kickbacks.
In July 2012, Michael Cobb, a physician’s assistant, was sentenced to six months in prison, six months home confinement, and ordered to forfeit $10,000 and pay a $3,000 fine for accepting kickbacks from Orthofix.
In December 2011, Mitchell Salzman pleaded guilty while he was a regional manager for Orthofix and is scheduled to be sentenced on January 31, 2013.
In September 2012, Brian Racey pleaded guilty to health care while he was a territory manager for Orthofix and is scheduled to be sentenced on February 2, 2013, in the U.S. District Court for the Eastern District of Pennsylvania.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations; the Federal Bureau of Investigation Boston Field Office; and the Department of Defense, Defense Criminal Investigative Service-Boston Resident Agency. It was being prosecuted by Assistant U.S. Attorneys David Schumacher and Jeremy Sternberg of Ortiz’s Health Care Fraud Unit.

Houston Man Sentenced for Health Care Fraud

SHREVEPORT, LA—United States Attorney Stephanie A. Finley announced today that Godspower Joseph Essang, 35, of Houston, Texas, was sentenced today, to 37 months in federal prison with three years’ supervised release for Medicare fraud.
Essang was also ordered to pay $613,096 in restitution to Medicare. Judge Maurice S. Hicks immediately remanded Essang into the custody of the U.S. Marshals Service to begin serving his sentence.
Essang was sentenced based on his September 28, 2012 guilty plea to one count of health care fraud. During the guilty plea hearing, Essang admitted owning and operating Shalom Equipment, a durable medical equipment company located on Woodward Avenue in Shreveport. Shalom engaged in the business of providing what were referred to as “ortho kits,” which were braces for various parts of the body. Essang admitted paying individuals to provide him with their Medicare beneficiaries and physicians information. He then used this identifying information to file false claims with Medicare for providing the “ortho kits” to Medicare beneficiaries who did not need, were not prescribed, and/or did not receive the items. Essang admitted that between August 12, 2007 and October 21, 2008, he filed approximately 736 claims, billing Medicare for $1,223,255. Medicare actually paid out $613,096 on the claims.
“Mr. Essang’s scheme was designed to defraud a program whose sole purpose is providing medical services to the elderly and the disabled,” U.S. Attorney Stephanie A. Finley stated. “His actions defrauded the program and, ultimately, U.S. taxpayers. This office will continue to vigorously pursue charges against those who steal from such programs.”
“Durable medical equipment fraud is a major problem that costs taxpayers billions in lost and wasted dollars,” said William W. Root, Assistant Special Agent in Charge, U.S. Department of Health and Human Services. “Today’s sentencing is the culmination of a concerted and joint effort by our Inspector General’s Office, the U.S. Attorney’s Office, and the Federal Bureau of Investigation to quickly bring to justice those who prey on our elderly for financial gain.”
The Federal Bureau of Investigation and the U.S. Department of Health and Human Services-Office of the Inspector General conducted the investigation. Assistant U.S. Attorney C. Mignonne Griffing prosecuted the case.

La Jolla Oncologist and Medical Practice Plead Guilty to Dispensing Unapproved Drugs

SAN DIEGO—A prominent La Jolla oncologist and his corporate medical practice have pleaded guilty in connection with a scheme to import unapproved foreign cancer drugs at a deep discount, dispense them to unwitting patients, bill Medicare as if the drugs were legitimate, and pocket the profits.
In a hearing before U.S. Magistrate Judge Bernard Skomal on January 15, Dr. Joel I. Bernstein entered a guilty plea to a single count of introducing an unapproved drug into interstate commerce—in this case, a cancer drug called “Mabthera” intended for market in Turkey—and administering it to patients. The approved U.S. drug with the same active ingredient is Rituxan, which is used to treat lymphomas and leukemias such as non-Hodgkin lymphoma and chronic lymphocytic leukemia. Bernstein was released pending sentencing, which is scheduled for April 16 at 1:30 p.m. before Judge Skomal.
In addition, his medical practice, Dr. Joel I. Bernstein, M.D. Inc., also pleaded guilty at a hearing today before U.S. District Judge Cathy Ann Bencivengo to one count of health care fraud. According to the plea agreement with the corporation, employees of Dr. Joel I. Bernstein, M.D. Inc. purchased $3.4 million of foreign cancer drugs, knowing they had not been approved by the U.S. Food and Drug Administration for use in the United States. From 2007 to 2011, Bernstein’s office purchased these drugs for significantly less than market value in the U.S. and then submitted claims to Medicare at the full reimbursement price. To conceal the scheme, the office fraudulently used Medicare reimbursement codes for approved cancer drugs, as Medicare does not pay for unapproved drugs.
The plea agreement for the corporation also calls for $1.7 million in restitution to Medicare, plus forfeiture of $1.2 million in profits. The corporate medical practice is scheduled to be sentenced on May 17, 2013, before Unites States District Judge Cathy Ann Bencivengo.
In addition, the government has also filed a False Claims Act lawsuit in District Court against Dr. Bernstein and his medical corporation for submitting false claims to the Medicare Program for these unapproved drugs. According to this civil complaint, the Medicare Program was defrauded of over $1.7 million, and under the False Claims Act, the United States can recover triple the amount of damages plus monetary penalties.
The cases involving Dr. Bernstein and his practice are the latest example of an alarming nationwide trend that potentially puts patients at risk by exposing them to foreign drugs—particularly injectable chemotherapy drugs—that are not vetted by the FDA. Agency officials have described the trend as an “epidemic of unapproved and counterfeit drugs.”
The FDA’s Office of Criminal Investigations (OCI) currently has over 200 investigations nationwide involving schemes in which medical practices purchase foreign, unapproved drugs and dispense them to unsuspecting patients for personal financial gain.
This practice is particularly disturbing because, unlike traditional prescription drugs which are dispensed to the patient by a pharmacy, oncology drugs are typically infused into a patient without the patient ever seeing the box it came in, or any of the related labeling.
“This isn’t just about the greed of one doctor but about the welfare of many patients,” said U.S. Attorney Laura Duffy. “In a worst-case scenario, chemotherapy drugs that have not been approved by the FDA may be fake, ineffective, unsafe, and dangerous. This is what motivates the Department of Justice and the FDA to be more aggressive in stopping those who would corrupt the integrity of the pharmaceutical supply chain with no regard for the well-being of patients.”
John Roth, director of the FDA’s Office of Criminal Investigations, the lead agency on the case, said, “When medical professionals decide that patient safety is less important than finding a great deal on pharmaceutical products from foreign countries and unknown suppliers our nation’s pharmaceutical supply chain is at risk and patients are vulnerable. FDA’s Office of Criminal Investigations will continue to investigate these cases and work closely with our regulatory counterparts in FDA and our law enforcement partners who share the same commitment to address this problem. We hope this message is heard loud and clear within the medical community—you will face criminal prosecution if you engage in this type of illegal activity.”
Daphne Hearn, Special Agent in Charge of the San Diego FBI, said, “Health care fraud costs the country billions of dollars each year and undermines the security of the Medicare program. The FBI will continue to work with our law enforcement partners and prosecutors to ensure the safety of the public and ensure the Medicare program will be there for those who need it most.”
Derek Benner, Special Agent in Charge of Immigration and Customs Enforcement’s Homeland Security Investigations, said, “As part of this case, HSI agents and our law enforcement partners uncovered an intricate network involved in the illicit distribution and importation of unapproved drugs that were sold to doctors in the U.S. It’s disturbing to see licensed, trusted medical professionals who are willing to put their own financial gain over public health and safety. We owe it to consumers to aggressively pursue pharmaceutical fraud given the significant risk to public health.”
According to the corporation’s plea agreement, Bernstein’s employees knowingly purchased foreign drugs containing the same active ingredient as drugs sold in the United States as Abraxane, Alimta, Aloxi, Boniva, Eloxatin, Gemzar, Neulasta, Rituxan, Taxotere, Venofer, and Zometa, but were intended for use in markets outside the United States and had not been approved for sale in the United States.
The medical practice, in pleading guilty, admitted that it was aware that the drugs were not approved by the FDA in part because the practice had received a notice from the FDA in October 2008 that a shipment of drugs had been detained because the drugs were not approved for use in the United States by the FDA. Despite this warning, Bernstein’s medical practice continued to purchase unapproved cancer drugs and inject them into patients.
The FDA regulates the introduction of pharmaceuticals into commerce. This regulation helps ensure that drugs are safely manufactured, made from appropriate ingredients, and properly labeled. The approval process addresses the chemical composition of the drug, the drug’s safety and effectiveness, and the elements of the drug’s distribution, such as the methods used in the manufacture, processing, and packing of the drug, as well as the labeling to be used for the drug.
Only drugs that comply with vigorous U.S. standards should be given to patients in this country. Drugs manufactured outside the United States that are not intended for use in the United States do not go through this approval process and are considered unapproved and therefore potentially unsafe.
In the Bernstein case, investigators found no evidence the illegal drugs involved were counterfeit. The unapproved foreign medications that were seized during the investigation were tested and found to contain the appropriate level of active ingredients. Although it’s difficult to determine whether a decline in a patient’s health should be attributed to unapproved drugs or to cancer, the investigation uncovered no evidence to indicate that Bernstein’s patients were harmed by the foreign drugs he administered.
There have been numerous similar cases of illegal importation and distribution of foreign unapproved drugs in San Diego and around the United States in recent years.
In cases related to Bernstein, a Florida-based cancer-drug supplier, Martin Paul Bean, III was indicted by a federal grand jury in San Diego in September 2012 for allegedly selling more than $7 million of misbranded and unapproved prescription oncology drugs to U.S. doctors. Please see 12-cr-03734-WQH USA.
The indictment alleged that from 2005 to 2011, Bean, doing business as GlobalRxStore; ordered the misbranded and unapproved drugs from foreign countries, including Turkey, India, and Pakistan; and sold them to the doctors throughout the U.S. at substantially discounted prices via a wholesale pharmacy in San Diego.
That pharmacy—Oberlin Medical Supply and Service Corp.—was owned and operated by Maher Idriss, who pleaded guilty March 8, 2012, to conspiring with Bean to supply the unapproved drugs. Idriss acknowledged that U.S. doctors paid him over $7 million for foreign-sourced unapproved oncology drugs from May 2006 to May 2011. Idriss faces up to five years in prison and restitution and has already forfeited approximately $54,000 of profits. He is scheduled for sentencing May 20, 2013. Please see 12- cr-01775-WQH.
According to the plea agreement for the Bernstein medical practice, employees ordered drugs from Oberlin, among other suppliers.
Idriss admitted that after receiving payments from the doctors, he transferred the funds to the foreign suppliers and to the GlobalRXStore owner’s bank account in Canada, keeping a portion for himself.
In another related case with a San Diego connection, James Newcomb of La Jolla was sentenced in August 2012 to 24 months in prison for conspiring to distribute adulterated prescription drugs to physicians in the United States. Newcomb admitted that he distributed unapproved prescription drugs from foreign countries to physicians located in the United States, with the assistance of persons in Canada and the United Kingdom. Please see 12-cr-00009-RWS-1.
Newcomb and others marketed these illegal drugs to U.S. doctors by offering them at up to 60 percent off the average wholesale price of the legitimate drugs in the United States.
According to the plea agreement of Bernstein’s medical practice, employees of his office purchased unapproved oncology drugs from Newcomb’s businesses, which included Medication Brokers, Pricing Logix, Richard’s Services, Ban Dune Marketing, and Warwick Healthcare Solutions. Newcomb based his operations in offices in La Jolla. La Jolla resident Sandra Behe and Dr. Abid Nisar of St. Louis, Missouri, were also convicted in the same investigation.
Elsewhere in the country, doctors, office staff, and drug suppliers in Maryland, Missouri, Tennessee, and California were indicted in similar schemes in 2011 and 2012. They were accused of importing misbranded cancer drugs at significantly cheaper prices, providing them to patients without disclosing the source of the drugs, and then submitting claims for reimbursement from healthcare programs.
It was the FDA’s discovery of two counterfeit drugs—Avastin, the approved blockbuster cancer drug for treatment of colorectal, lung, kidney, and brain cancer; and Altuzan, the unapproved Turkish version of Avastin—that brought national media attention to the problem. The Altuzan was found to contain no active ingredient at all and thus would provide no benefit whatsoever to patients.
The FDA, recognizing the seriousness of this illegal activity and the discovery of the counterfeit Avastin and Altuzan, took the unprecedented regulatory action of issuing letters to numerous medical practices and physicians around the country, including many that purchased unapproved cancer drugs. To date over 500 letters have been issued.
Dr. Bernstein was among those who received a letter from the FDA prior to being charged with federal crimes.
The letter to Bernstein said, in part, “Purchasing prescription drug products, such as injectable cancer medications, from foreign or unlicensed suppliers puts patients at risk of exposure to drugs that may be fake, contaminated, improperly stored and transported, ineffective, and dangerous. In virtually all cases, purchasing unapproved prescription drugs from foreign sources violates the Federal Food, Drug, and Cosmetic Act and is illegal.”
The letter warned of the risks of purchasing medications from foreign, unfamiliar, or unlicensed suppliers and selling unapproved versions of injectable cancer medications, noting that “patients were unknowingly placed at risk when they received medications of uncertain purity, storage, handling, identity, and sourcing.”
The letter also noted that importing these medications from foreign sources is a violation of the Federal Food, Drug, and Cosmetic Act.
“In an effort to protect the health of patients, health care providers should use only FDA-approved versions of these cancer medications,” the letter said. “Health care providers should be aware that purchasing medications from direct-to-clinic promotions that are from non-verified sources might increase the risk of receiving a potentially unsafe and ineffective product, since the products offered for sale may be unapproved, not manufactured with the quality attributes of FDA-approved products, or counterfeit.”
Defendant Criminal Case No. 13cr0120-BGS
Joel I. Bernstein
Summary of Charges
Title 21, United States Code, Section 331(d), 333(a) (1) and 355(a), a misdemeanor—introducing or causing to be introduced into interstate commerce an unapproved new drug
Maximum Penalties
One year in prison; $100,000 fine, one year supervised release, restitution.
Defendant in Criminal Case No. 13cr0119-CAB 
Dr. Joel I. Bernstein, M.D. Inc.
Summary of Charges
Title 18, United States Code, Section 1347—medicare fraud
Maximum Penalties
Five years’ supervised release, $500,000 fine, mandatory restitution.
Investigating Agencies
The U.S. Food and Drug Administration’s Office of Criminal Investigations was the lead investigative agency in this case. Other agencies involved were the Federal Bureau of Investigation and Immigration and Customs Enforcement’s Homeland Security Investigations. The lead prosecutor is Melanie Pierson.

Former Miami Clinic Director Sentenced to 70 Months in Prison for Role in HIV Infusion Fraud Scheme

WASHINGTON—A former Miami HIV infusion clinic director was sentenced today to serve 70 months in prison for his role in a $26.2 million HIV infusion fraud scheme, announced Assistant Attorney General Lanny Breuer of the Criminal Division, U.S. Wifredo A. Ferrer of the Southern District of Florida, Acting Special Agent in Charge Michael B. Steinbach 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.
Enrique Gonzalez, 67, formerly of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Judge Altonaga sentenced Gonzalez to serve three years of supervised release and ordered him to pay $17,590,896 in restitution to HHS.
On November 13, 2012, Gonzalez pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks, and one count of conspiracy to commit health care fraud.
Gonzalez admitted that between August 2002 and March 2004, he conspired with co-defendant Ronald Harris, a Miami physician, and alleged co-conspirators to operate Physicians Med-Care and Physicians Health (together the “Physicians Clinics”), two Miami HIV infusion clinics. According to court documents, the Physicians Clinics were owned and controlled by alleged co-conspirators Carlos Benitez and his brother Luis Benitez. The Physicians Clinics purported to specialize in treating patients with HIV but were operated for the sole purpose of committing Medicare fraud, according to court documents. Gonzalez was a director of Physicians Med-Care and, at the direction of his co-conspirators, was responsible for the finances of the Physicians Clinics.
Gonzalez admitted that he agreed with his co-conspirators to handle the finances for the Physicians Clinics, moving the money paid by the Medicare program out of the Physicians Clinics’ accounts and into accounts owned and controlled by his co-conspirators. According to court documents, Harris signed blank checks that Gonzalez used to transfer funds to various Benitez-owned entities and others, as directed by his co-conspirators. In addition, Gonzalez agreed to provide cash to various co-conspirators at the Physicians Clinics to be used to pay bribes and kickbacks to the Medicare beneficiaries in return for those beneficiaries allowing the Physicians Clinics to bill the Medicare program for HIV infusion services that were not medically necessary and often not provided.
Gonzalez admitted that during his association with Physicians Med-Care, the clinic billed the Medicare program approximately $24.5 million in HIV infusion therapy claims, for which the clinic received $16.7 million in payments. Gonzalez also admitted that during his time with Physicians Health, the clinic billed Medicare approximately $1.7 million and received approximately $800,000 in payment from the Medicare program for fraudulent services.
Gonzalez was a fugitive from justice from the time of his indictment in 2008, until he was located and detained in Peru in late 2011. Gonzalez was extradited to the United States in July of 2012. Gonzalez’s daughter, Carmen Gonzalez, was indicted in a related case and is currently a fugitive.
Co-defendant Harris pleaded guilty on August 26, 2008, to one count of conspiracy to defraud the United States, to cause the submission of false claims and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. Harris pleaded guilty in connection with his role as the medical director for the Physicians Clinics. On November 4, 2008, Harris was sentenced to serve 84 months in prison for his role in the scheme.
Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes in an indictment unsealed on June 11, 2008. According to the separate indictment, the defendants provided the money and staff necessary to open the Physicians Clinics, the Medicare patients that the clinics needed to bill the Medicare program and transportation for the HIV patients who visited the clinics. Carlos and Luis Benitez and McKenzie were charged for their role in committing approximately $109 million in HIV infusion fraud and money laundering through the Physicians Clinics and nine other HIV infusion clinics.
On September 18, 2008, McKenzie pleaded guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program and admitted to his role in a $119 million HIV infusion fraud scheme. On December 18, 2008, McKenzie was sentenced to serve 14 years in prison.
Carlos and Luis Benitez are also fugitives. Anyone with information regarding the whereabouts of the fugitives is urged to contact HHS-OIG fugitive reporting phone line at 888-476-4453.
The defendants who have not been convicted are presumed innocent unless and until proven guilty.
The Physicians Med-Care and Physicians Health case is being prosecuted by Trial Attorney N. Nathan Dimock of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the DHS Office of Inspector General.
The case was 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. The Department also thanks the Peruvian National Police Interpol Unit for their assistance.
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.

Four Sentenced to Prison in Community Mental Health Center Case

WASHINGTON—The owners of three Miami-area assisted living facilities and an affiliated psychologist were sentenced to prison today in connection with a health care fraud scheme involving now-defunct Miami-area health provider Health Care Solutions Network Inc. (HCSN) in which Medicare was billed for mental health treatments that were unnecessary or not provided.
The sentences were announced by 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.
U.S. District Judge Cecilia M. Altonaga sentenced Serena Joslin, 32, of Looneyville, West Virginia, to 63 months in prison, following her previous guilty plea to conspiracy to commit health care fraud. Raymond Rivero, 55, Daniel Martinez, 46, and Ivon Perez, 50, all of Miami, were each sentenced to 28 months in prison. All three had previously pleaded guilty to conspiracy to violate the anti-kickback statute.
According to court documents, HCSN operated community mental health centers both in Miami and North Carolina, including partial hospitalization programs (PHP)—a form of intensive treatment for severe mental illness. HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided.
In Miami, HCSN obtained beneficiaries by paying kickbacks to owners and operators of assisted living facilities (ALF) or by otherwise recruiting them from the facilities and from nursing homes. Rivero, Martinez, and Perez admitted during their guilty pleas to referring Medicare beneficiaries to HCSN in exchange for cash bribes. Rivero, former owner of Miami-based God Is First ALF; Martinez, former owner of Homestead, Florida-based Mi Renacer ALF; and Perez, former owner of Homestead-based Kayleen and Denis Care Corp., are no longer permitted to operate such facilities as a condition of their guilty pleas.
According to court documents, ALF residents referred to HCSN by Rivero, Martinez, and Perez were not qualified to be placed in 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, mental retardation, or were otherwise unable to benefit from mental health services.
According to court documents, Joslin, a licensed psychologist, was hired by HCSN in North Carolina in April 2010 as a clinical coordinator and later promoted to clinical director. In those roles, she conspired with other HCSN employees to fabricate medical documents to substantiate alleged PHP treatment that was medically unnecessary and, in many instances, not even provided to the beneficiaries. Joslin admitted that many of the HCSN patients were unqualified for the PHP program because they suffered from conditions such as mental retardation and dementia and that she directed therapists to fabricate medical records to support HCSN’s fraudulent billing to the Medicare program. Joslin was also required to surrender her North Carolina license to provide mental health treatment as part of her plea agreement.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.
In addition to the prison terms, Judge Altonaga sentenced Joslin, Rivero, Martinez, and Perez each to serve three years of supervised release and ordered them to pay $4,464,728; $90,896; $76,358; and $89,245 in restitution, respectively.
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 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.

Social Worker Indicted for Health Care Fraud

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced today that a federal grand jury in Buffalo has returned a five-count indictment charging Nina Jafari, a licensed clinical social worker, 62, of Amherst, New York, with health care fraud. The charge carries a maximum penalty of 10 years years in prison, a fine of $250,000, or both.
Assistant U.S. Attorney Michael DiGiacomo, who is handling the case, stated that according to the indictment, the defendant defrauded Blue Cross Blue Shield of Western New York. The scheme involved Jafari submitting reimbursement claim forms to Blue Cross Blue Shield for services that were not rendered. The amount totaled approximately $125,000.
The indictment is the culmination of an investigation on the part of special agents of the Federal Bureau of Investigation, under the direction of Special Agent in Charge Christopher M. Piehota.
The fact that a defendant has been charged with a crime is merely an accusation, and the defendant is presumed innocent until and unless proven guilty.