Miami Physician Sentenced to 30 Years in Prison for $11 Million Medicare Fr... (necessary HIV infusion treatments at the...)

Miami Physician Sentenced to 30 Years in Prison for $11 Million Medicare Fraud Scheme

Date:12/17/2008

necessary 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
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