Date: June 28, 2023 Contact: newsroom@ci.irs.gov MIAMI — U.S. Attorney Markenzy Lapointe announced criminal charges against fourteen defendants in connection with over $1.9 billion in fraud prosecuted in the Southern District of Florida, as part of the Department of Justice's 2023 National Health Care Fraud Enforcement Action. The charges stem from various schemes to defraud government and private health care benefit programs by submitting false claims for items and services that were not needed and, in many instances, never provided as well as a scheme to unlawfully distribute adulterated and misbranded prescription medications. "The results of this nationwide coordinated law enforcement effort that we announce today exemplify our office's ongoing commitment to prosecuting health care fraud-related schemes," said U.S. Attorney Markenzy Lapointe for the Southern District of Florida. "We will continue to hold accountable those who exploit health care programs for personal profit in South Florida." "These enforcement actions, including against one of the largest health care fraud schemes ever prosecuted by the Justice Department, represent our intensified efforts to combat fraud and prosecute the individuals who profit from it," said Attorney General Merrick B. Garland. "The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs." "This nationwide enforcement action demonstrates that the Criminal Division is committed to fighting health care fraud and opioid abuse by prosecuting those who allegedly exploit patients and health care benefit programs for personal gain," said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department's Criminal Division. "Today's announcement includes some of the largest and most complex cases that the Department has prosecuted, and demonstrates the Department's commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care, from professionals in doctors' offices to executives in corporate boardrooms." The charges announced today by U.S. Attorney Lapointe are part of a strategically coordinated, two-week nationwide law enforcement action that resulted in criminal charges against 78 defendants for their alleged participation in health care fraud and opioid abuse schemes that resulted in the submission of over $2.5 billion in alleged false billings. The defendants allegedly defrauded programs entrusted for the care of the elderly and disabled, and, in some cases, used the proceeds of the schemes to purchase luxury items, including exotic automobiles and yachts. The Health Care Fraud Unit's Strike Forces in Brooklyn, Dallas, Detroit, the Gulf Coast, Houston, Los Angeles, Miami, Newark, and Tampa; the Health Care Fraud Unit's National Rapid Response Strike Force; the U.S. Attorneys' Offices for the Middle District of Florida, Southern District of Florida, Southern District of Georgia, District of Idaho, Western District of Kentucky, Eastern District of Louisiana, Middle District of Louisiana, District of New Jersey, Eastern District of New York, Southern District of Ohio, District of South Carolina, Southern District of Texas, Eastern District of Washington, and Eastern District of Wisconsin; and the State Attorney Generals' Offices for Indiana, New York, and Pennsylvania are prosecuting the cases in the National Enforcement Action, with assistance from the Health Care Fraud Unit's Data Analytics Team. The Southern District of Florida, in particular, worked with the Department's Criminal Division and the following law enforcement organizations to investigate and prosecute the cases filed during the enforcement period: IRS Criminal Investigation (IRS-CI), Miami Field Office; the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Miami Region; FBI, Miami Field Office; the Federal Deposit Insurance Corporation Office of Inspector General (FDIC-OIG), Atlanta Region; the Department of Defense Office of Inspector General (DOD OIG), Defense Criminal Investigative Service, Southeast Field Office, the U.S. Department of Veterans Affairs Office of Inspector General (VA-OIG), Southeast Field Office; and the Office of Personnel Management, Office of Inspector General (OPM-OIG). "Federal health care programs are designed to provide access to high quality care to patients nationwide. When bad actors attempt to exploit those measures for illicit financial gain, they put greed before the needs and safety of their patients, and take valuable resources away from their intended recipients," said Deputy Inspector General for Investigations Christian J. Schrank of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). "As today's enforcement action illustrates, HHS-OIG and our law enforcement partners are committed to defending the federal health care system against fraud." "These cases serve to highlight the magnitude of health care fraud in South Florida, but unfortunately are only the tip of the iceberg," said Jeffrey B. Veltri, Special Agent in Charge, FBI Miami. "Our health care system is under constant attack by fraudsters who are driven by greed. They pilfer billions of dollars from Medicare and other health care benefit programs. The FBI, Health and Human Services Office of Inspector General, Federal Deposit Insurance Corporation Office of Inspector General, Department of Defense Office of Inspector General, the United States Attorney's Office for the Southern District of Florida, and the Department of Justice devote considerable resources to investigate, arrest, and prosecute these criminals. We will not relent. But, we need the public's assistance. Please report suspicious activity, inform your insurance company if you see charges on your explanation of benefits for services you did not receive and protect your insurance cards and other personally identifiable information." "The cases described in today's announcement reflect the FDIC OIG's commitment to investigating allegations of fraud, including health care fraud schemes, that threaten to undermine the integrity of our Nation's banking system," said Assistant Inspector General for Investigations Shimon R. Richmond of the Federal Deposit Insurance Corporation Office of Inspector General (FDIC-OIG). "We will continue to coordinate with our law enforcement partners to investigate such schemes, and are pleased to join them in announcing today's enforcement action." "This indictment is an important step in protecting federal health care programs from fraudulent billing and ensuring patients receive uncompromised care through the Department of Defense's TRICARE Program," stated Special Agent in Charge Darrin Jones, Department of Defense Office of Inspector General, Defense Criminal Investigative Service, Southeast Field Office. "We will continue to work closely with our law enforcement partners to hold health care fraudsters accountable and to protect patient health and safety." The following defendants have been charged in the Southern District of Florida: In United States v. Rubier, Case No. 23-cr-80105, Yosbel Roque Rubier of Miami, Florida, was charged by indictment with health care fraud and aggravated identity theft in connection with an alleged scheme to defraud Medicare of approximately $900,000 for durable medical equipment ("DME") that was never supplied to Medicare beneficiaries. As alleged in the indictment, Rubier was the owner and operator of FCM Supply LLC ("FCM"), a clinic in Greenacres, Florida, that purported to provide DME to eligible Medicare beneficiaries. In a four-month period, FCM submitted approximately $900,000 in allegedly fraudulent health care claims to Medicare for DME that FCM never provided, and that Medicare beneficiaries never requested or needed. To support these fraudulent claims, Rubier used stolen means of identification of medical providers. As a result, Medicare paid approximately $443,000 to FCM. FBI Miami and HHS-OIG Miami investigated the case. Assistant U.S. Attorney Shannon Shaw is prosecuting it. In United States v. Cesar, Case No. 23-cr-20259, Tania Cesar of Hialeah, Florida, was charged by indictment with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by Blue Cross Blue Shield ("BCBS"). As alleged in the Indictment, Cesar was a licensed physical therapist assistant at Elite Therapy Group, Inc ("Elite Therapy"), a physical therapy clinic in Miami, Florida. Cesar signed patient therapy records misrepresenting that she had provided physical therapy to insurance beneficiaries, when in fact she had not. Cesar's co-conspirators at Elite Therapy, who were convicted for the Elite Therapy conspiracy in United States v. Wated et al., Case No. 21-cr-20110-MGC, submitted millions of dollars in claims to BCBS for physical therapy that Cesar purported to provide, but never did. FBI Miami investigated the case. Assistant U.S. Attorney Joseph Egozi is prosecuting it. Assistant U.S. Attorney Joshua Paster is handling asset forfeiture. In United States v. Bernal, Case No. 23-cr-20246, Arian Bernal of Hialeah, Florida, was charged by information with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by Blue Cross Blue Shield ("BCBS"). As alleged in the information, Bernal paid kickbacks to beneficiaries to recruit them to visit several Miami clinics so that his co-conspirators could submit claims to those beneficiaries' ASO insurance plans managed by BCBS. Those claims fraudulently represented that various health care benefits and services were medically necessary and provided to patients. FBI Miami investigated the case. Assistant U.S. Attorney Joseph Egozi is prosecuting it. Assistant U.S. Attorney Joshua Paster is handling asset forfeiture. In United States v. Perez, Case No. 23-cr-20269, Silvana Perez of Miami, Florida, was charged by information with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by Blue Cross Blue Shield ("BCBS"). As alleged in the information, Perez paid kickbacks to beneficiaries to recruit them to visit a sleep study clinic so that her co-conspirators could submit claims to those beneficiaries' ASO insurance plans managed by BCBS. Those claims fraudulently represented that various health care benefits and services were medically necessary and provided to patients. FBI Miami investigated the case. Assistant U.S. Attorney Joseph Egozi is prosecuting it. Assistant U.S. Attorney Joshua Paster is handling asset forfeiture. In United States v. Gonzalez, et al., Case No. 23-20248, Ariel Gonzalez of Naples, Florida, and Linda Taylor, 55, of Miami, Florida, were charged for their roles in an alleged health care fraudulent billing scheme, along with several others who were previously charged in a separate Indictment and have since pleaded guilty. According to the Indictment, Gonzalez was one of the owners of Phoenix Rehab Center Corp., a physical therapy clinic based in Miami, that offered and paid kickbacks to patient recruiters, including Taylor, in exchange for referring beneficiaries of Administrative Services Only corporate insurance plans held by employers JetBlue Airways and AT&T Inc. and administered by Blue Cross Blue Shield to Phoenix Rehab for various forms of physical therapy treatments that they did not need and in many cases never received. The indictment further alleges that Gonzalez provided funding to Phoenix Rehab to further the fraud, including by taking out a loan to obtain sufficient cash to pay kickbacks to patient recruiters and beneficiaries. FBI Miami investigated the case. Assistant U.S. Attorney Will J. Rosenzweig is prosecuting it. Assistant U.S. Attorney Annika Miranda is handling asset forfeiture. In United States v. Gomez, Case No. 23-cr-20249, Carlos Jose Martin Gomez of Miami, Florida, was charged for his role in an alleged health care fraudulent billing conspiracy in conjunction with Arisleidys Fernandez Delmas, 32, of Miami, Florida and several others who were previously charged in separate indictments. The scheme involved several fraudulent physical therapy clinics that targeted Administrative Services Only corporate insurance plans held by employers JetBlue Airways, AT&T Inc., and TJX Companies Inc. and administered by Blue Cross Blue Shield. Martin Gomez was also charged with five substantive counts of health care fraud related to five clinics involved in the larger conspiracy. According to the indictment, Martin Gomez offered and paid kickbacks and bribes to patient recruiters for referring beneficiaries to the clinics and directly to beneficiaries of these insurance plans in exchange for allowing the clinics to bill these plans for various forms of physical therapy treatments purportedly provided to these beneficiaries that they did not need and in many cases never received. FBI Miami investigated the case. Assistant U.S. Attorney Will J. Rosenzweig is prosecuting it. Assistant U.S. Attorney Annika Miranda is handling asset forfeiture. In United States v. Lazo, Case No. 23-cr-20250, Adrian Lazo of Miami, Florida, was charged with laundering health care fraud proceeds by depositing a $3,303,974 check from the Center for Medicare and Medicaid Services to YG Medical Supplies Inc. in October 2021. The indictment alleges that Lazo conspired with others to deposit the check for the purpose of concealing, among other things, the nature, source, and ownership of those funds. HHS-OIG Miami, DOD-OIG, Southeast Field Office, FDIC-OIG, Atlanta Region, and HSI Miami investigated the case. Assistant U.S. Attorney Will J. Rosenzweig is prosecuting it. Assistant U.S. Attorney Annika Miranda is handling asset forfeiture. In United States v. Moreno, Case No. 23-cr-20266, Jesus Enrique Moreno of Miami, Florida, was charged by information with unlicensed money transmitting for transmitting health care fraud proceeds between December 2020 and February 2021. HHS-OIG Miami and FDIC-OIG, Atlanta Region, investigated the case. Assistant U.S. Attorney Timothy J. Abraham is prosecuting it. Assistant U.S. Attorney Mitchell Hyman is handling asset forfeiture. In United States v. Blackman, et al., Case No. 23-cr-20271, Brett Blackman of Johnson County, Kansas, Gary Cox of Maricopa County, Arizona, and Gregory Schreck of Johnson County, Kansas, were charged by indictment with conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive kickbacks, and conspiracy to defraud the United States and make false statements, in connection with the submission of $1.9 billion in false and fraudulent claims to Medicare and other government insurers for orthotic braces, prescription skin creams, and other items that were medically unnecessary and ineligible for Medicare reimbursement. As alleged in the indictment, Blackman, Cox, and Schreck owned, controlled, or operated DMERx, which was an internet-based platform that the defendants programmed to generate false and fraudulent doctors' orders in exchange for illegal kickbacks and bribes. Cox was the CEO of the company that operated DMERx prior to a corporate acquisition, and Blackman was the CEO and Schreck a Vice President of the company that operated it after the acquisition. The defendants are alleged to have offered to connect pharmacies, durable medical equipment ("DME") suppliers, and marketers to telemedicine companies who would accept illegal kickbacks and bribes in exchange for orders that were transmitted using the DMERx platform. The defendants allegedly received payments for coordinating these illegal kickback transactions and referring the completed doctors' orders to the DME suppliers, pharmacies, and telemarketers that paid for them. The fraudulent orders and prescriptions generated by DMERx falsely represented that doctors had examined and treated the Medicare beneficiaries when in reality, purported telemedicine companies paid doctors to sign these orders and prescriptions without regard to medical necessity and based on a brief telephone call with the beneficiary or sometimes no interaction with the beneficiary at all. In order to conceal and disguise the scheme, and obstruct investigations by Medicare and its contractors, the defendants allegedly removed references to telemedicine in the orders. The DME supply companies and pharmacies that paid illegal kickbacks in exchange for these orders and prescriptions generated through DMERx billed Medicare more than $1,963,000,000 in false and fraudulent claims. HHS-OIG Miami, FBI Miami, VA-OIG, Southeast Field Office, IRS-CI Miami, HSI Miami, OPM-OIG, DOD OIG, Southeast Field Office, investigated the case. Trial Attorneys Darren C. Halverson of the National Rapid Response Strike Force and Andrea Savdie of the Miami Strike Force are prosecuting it. Assistant U.S. Attorney G. Raemy Charest-Turken is handling asset forfeiture. In United States v. Herrera, Case No. 23-cr-20264, Armando Herrera of Miami, Florida, was charged by information with one count of conspiracy to introduce adulterated and misbranded drugs into interstate commerce in connection with a nationwide scheme to unlawfully distribute adulterated and misbranded prescription medications, including HIV medications, valued at more than $16.7 million. As alleged in the information, Herrera and his co-conspirators illegally acquired these prescription medications through fraud or from individual patients for whom the prescription medications had been prescribed. The information alleges that these medications were then repackaged and resold with false labeling and documentation to conceal their true origin. It further alleges that, in some instances, the prescription medications Herrera distributed contained the wrong medication. HHS-OIG Miami and FDIC-OIG, Atlanta Region, investigated the case. Trial Attorney Alexander Thor Pogozelski of the Miami Strike Force is prosecuting it. Assistant U.S. Attorney Daren Grove is handling asset forfeiture. In United States v. Vines, Case No. 23-cr-80107, Reginal N. Vines of Tuscaloosa, Alabama, was charged by indictment with conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, and receiving health care kickbacks, in connection with his role in selling doctors' orders for medically unnecessary genetic tests to several laboratories. Vines obtained the orders by paying kickbacks and bribes to a doctor in exchange for the doctor signing prescriptions for genetic tests, without ever meeting or treating the Medicare beneficiaries for whom the tests were orders. In some instances, Vines allegedly forged the doctor's signature on the prescriptions. The indictment alleges that the laboratories billed Medicare approximately $10 million for medically unnecessary genetic tests, of which Medicare paid $2.9 million. HHS-OIG Miami and FBI Miami investigated the case. Trial Attorney Reginald Cuyler Jr. of the Miami Strike Force is prosecuting it. Assistant U.S. Attorney Marx Calderon is handling asset forfeiture. In addition to the above defendants charged in the Southern District of Florida, a defendant was sentenced earlier this month to 15 years in federal prison in connection with a nationwide scheme to unlawfully distribute diverted, adulterated, and misbranded medications, including HIV drugs: In United States v. Hernandez, Case No. 22-cr-60129, Lazaro Hernandez of Miami, Florida, was sentenced on June 15 to 15 years in prison after pleading guilty to conspiracy to defraud the United States and to introduce into interstate commerce adulterated and misbranded drugs and conspiracy to commit money laundering, in connection with a nationwide scheme to unlawfully distribute more than $230 million in diverted, adulterated, and misbranded medications, including HIV drugs. According to court documents, Hernandez and his co-conspirators illegally acquired large quantities of prescription drugs from patients for whom the drugs had been prescribed but intentionally not consumed. Hernandez and his co-conspirators then sold the diverted drugs to pharmacies across the country. The diverted drugs were accompanied by false pedigrees to conceal their true origin. In at least several instances, the diverted HIV medication that Hernandez sold consisted of bottles containing the wrong medication, broken pills, and even pebbles, leading to complaints by pharmacies. Hernandez and his co-conspirators then laundered the proceeds of these illegal sales. Hernandez also used his share of the proceeds to purchase luxury goods, including a $280,000 Lamborghini, a $220,000 Mercedes, and three boats. HHS-OIG Miami and FDIC-OIG, Atlanta Region, investigated the case. Assistant U.S. Attorney Timothy J. Abraham and Trial Attorney Alexander Thor Pogozelski of the Miami Strike Force prosecuted it. Assistant U.S. Attorney Emily Stone is handling asset forfeiture. A complaint, information, or indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
