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Miami Jury Convicts Dermatologist of Medicare Fraud

Ninth Trial Conviction for Medicare Fraud Strike Force

WASHINGTON, April 30 /PRNewswire-USNewswire/ -- A federal jury in Miami convicted dermatologist Ana Caos, M.D., late yesterday of Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

After a nine-day trial in Miami, the jury found Caos, 62, guilty on all charged counts, including: conspiracy to defraud the U.S. government, to cause the submission of false claims to Medicare, and to solicit and receive kickbacks; and conspiracy to commit health care fraud. Caos was originally convicted on March 7, 2008, but the court ordered a retrial based on issues that arose during Caos' prior testimony. Sentencing on this conviction has been scheduled for July 18, 2008. Caos faces a maximum of 15 years in prison.

At trial, the jury heard testimony from Caos' patients that she wrote prescriptions for medications that the patients did not want or need, solely for the purpose of billing Medicare for the medications. The patients testified that they were falsely diagnosed with chronic obstructive pulmonary disease (COPD) and therefore prescribed unnecessary compounded aerosol medications that they threw in the trash immediately upon receipt.

An expert pulmonologist from the University of Miami Medical School testified that prescribing compounded aerosols for the treatment of COPD was unnecessary because there are numerous commercially available medications that can be prescribed. Compounding is the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.

As part of these conspiracies, Caos wrote unnecessary prescriptions for homemade compounded medicines for more than 40 patients. Between February 2001 and June 2003, Medicare was billed $620,000 by complicit pharmacies for unnecessary aerosol prescriptions; by complicit durable medical equipment (DME) companies for equipment used with those drugs; and for visits to Caos.

Another former physician, Pedro Cuni, who is currently serving time in prison for Medicare fraud, testified that Maria Hernandez, the owner of Action Best Medical Supplies Inc., informed him that she was utilizing Caos to write false prescriptions. The jury also heard testimony from Orlando Pascual, another company owner who is serving time in prison for Medicare fraud, that he purchased prescriptions from Caos at $100 per prescription.

In 2006, the Medicare program paid for more than $155 million worth of aerosol medications in Miami-Dade County alone. These drugs were the single most common item billed to Medicare Part B and accounted for more than 32 percent of all equipment claims filed in Miami-Dade County. From 2005 to 2006, claims for aerosol medications rose more than 100 percent in Miami-Dade County. According to Medicare data, Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan and Ohio. In June 2007, the Centers for Medicare and Medicaid Services ceased paying for compounded aerosol medication because it determined that they were medically unnecessary.

The case was prosecuted by Deputy Chief Kirk Ogrosky and Trial Attorney John S. (Jay) Darden of the Criminal Division's Fraud Section, with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General and the FBI. The case was brought as part of the Medicare Fraud Strike Force that has been operating in Miami since March 2007. The Strike Force is led by Deputy Chief 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.

SOURCE U.S. Department of Justice
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