Prison Sentence One of the Longest Ever Received by a Physician in a Medicare Fraud Case
A Miami physician and nurse were sentenced today to 30 years and seven years in prison, respectively, in connection with their roles in an $11 million HIV infusion fraud scheme, Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced. The 30-year prison sentence is one of the longest terms ever given to a physician in a federal Medicare fraud case.
Ana Alvarez-Jacinto, 54, and Sandra Mateos, 44, were sentenced today in U.S. District Court for the Southern District of Florida by Chief District Judge Federico Moreno. In addition to their prison sentences, Judge Moreno ordered both Alvarez-Jacinto and Mateos to serve three years of supervised release following their prison term and to pay $8,289,286 in restitution to the Medicare program.
Alvarez-Jacinto and Mateos were found guilty by a Miami jury on Oct. 17, 2008, after a two-week trial on one count of conspiracy to defraud the United States, to submit false claims, and to pay healthcare kickbacks, and one count of conspiracy to commit health care fraud. Alvarez-Jacinto was also convicted of three counts of submitting false claims to the Medicare program.
Evidence at trial established that the defendants worked at Saint Jude Rehab Center, Inc. (St. Jude), a clinic that purported to specialize in treating AIDS patients. Evidence at trial established that St. Jude was operated and owned by Carlos and Luis Benitez, and managed by convicted co-conspirators Aisa Perera and Mariela Rodriguez.
According to evidence presented at trial, in a five-month period between June and November 2003, Alvarez-Jacinto, with the assistance of Mateos, ordered hundreds of medically unnecessary HIV infusion treatments at the clinic. Evidence established that HIV positive Medicare patients were brought to the clinic by Carlos and Luis Benitez for the purpose of receiving cash payments in exchange for allowing the clinic to bill for unnecessary treatments. Testimony revealed that Mateos and other co-conspirators paid the patients cash kickbacks of approximately $150 per visit. After patients had been paid, they agreed to allow Alvarez-Jacinto and her co-conspirators to prescribe unnecessary infusion treatments. St. Jude then billed Medicare for approximately $11 million for the unnecessary services during that five-month period. For those claims, Medicare paid more than $8 million to St. Jude.
“This is a case in which a physician provided unneeded medical services in the form of infusions to actual ‘patients’ simply to bilk Medicare and make a fast buck,” said Acting Assistant Attorney General Matthew Friedrich. “This sentence should send a clear message that health care providers who engage in fraud will not escape accountability because of their professional status.”
“False billings to Medicare for services not delivered is a serious crime that depletes our limited Medicare dollars. Far worse, however, is when medical professionals like the doctor and nurse sentenced today, actually order and perform medically unnecessary treatments to pad bills and make more money. Such conduct is inexcusable and will be prosecuted,” said U.S. Attorney R. Alexander Acosta.
“Medical professionals are considered respected members of the community, but when that trust is broken, they are not insulated from having to take responsibility for their criminal behavior,” said Special Agent in Charge Jonathan I. Solomon of the FBI’s Miami Office. “This case demonstrates that those who choose to commit health care fraud, regardless of their stature or position, will be held accountable for their actions.”
“The Office of Inspector General is very pleased with today’s sentencing and will continue to aggressively investigate those who defraud the Medicare system. This type of greed, at the expense of our most vulnerable citizens will not be tolerated,” said Christopher B. Dennis, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General – Miami region.
After trial, advertising placed in El Nuevo Herald proclaimed Alvarez-Jacinto’s innocence and a letter signed by the defendant contained in the advertisement urged members of the medical community to write to the court to support her release from prison. At sentencing, Chief District Judge Moreno found her trial testimony to be perjurious and enhanced her sentence for obstruction of justice.
Carlos Benitez, Luis Benitez and Jose Benitez, were indicted on June 11, 2008, for their role in an HIV infusion and money laundering scheme that totaled more than $100 million for claims submitted by St. Jude and other clinics. The indictment alleges that Carlos, Luis and Jose Benitez were the masterminds of a large-scale HIV infusion fraud operation throughout South Florida involving at least 11 clinics, including St. Jude, and that they laundered the proceeds of their crimes. All three Benitez brothers remain at large.
An indictment is merely a charge, and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt.
This case was prosecuted by Senior Trial Attorney Charles E. Duross, and Trial Attorneys John K. Neal and Laura Perkins of the Criminal Division’s Fraud Section. The case was investigated by the FBI and the Department of Health and Human Services, Office of the Inspector General.
The case was brought by the Medicare Fraud Strike Force (MFSF). The MFSF is a multi-agency team of federal, state and local prosecutors and agents designed to combat Medicare fraud. Strike force operations began in the Miami-area on March 1, 2007. The MFSF is led by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section in Washington, D.C., and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida. Since the inception of MFSF operations in 2007, federal prosecutors have indicted 106 cases with 188 defendants in both Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.
Source: U.S. Department of Justice