WASHINGTON, Nov. 20 Miami physicians Carlos Contreras, 61, and Ramon Pichardo, 58, were sentenced today to 37 months and 48 months in prison, respectively, for defrauding the Medicare program in connection with a $6.8 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.
Judge Federico A. Moreno of the U.S. District Court for the Southern District of Florida also ordered that Contreras and Pichardo be placed on three years of supervised release following their prison terms and that they pay $4.2 million in restitution to the Medicare trust fund.
On Sept. 11, 2008, Contreras and Pichardo each pleaded guilty to one count of conspiracy to commit health care fraud. Contreras pleaded guilty in connection with his role as the owner and medical doctor at CNC Medical Corp. (CNC Medical), a Miami-area HIV clinic that purported to provide HIV infusion services to Medicare beneficiaries. Pichardo pleaded guilty in connection with his role as a medical doctor at CNC Medical. In their pleas, Contreras and Pichardo admitted that between November 2002 and April 2004, they conspired with others to file $6.8 million in false claims to the Medicare program for HIV infusion services that were not provided, nor were they medically necessary. As a result of their fraud, the Medicare program paid approximately $4.2 million in fraudulent bills. Contreras admitted that after Medicare proceeds were deposited into the CNC Medical bank accounts, he transferred approximately $1.7 million of the proceeds to sham management, marketing and investment companies owned and operated by alleged co-conspirators Carlos, Luis and Jose Benitez.
Carlos Benitez, 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 that indictment, these co-conspirators allegedly provided the money and staff necessary to open HIV clinics, the Medicare patients that the clinics would bill to the Medicare program and transportation for the HIV patients who visited the clinics. Also according the indictment, Carlos and Luis Benitez were the true owners of the clinics. The Benitez brothers and McKenzie were charged for their roles at the clinics and eight other HIV infusion clinics. On Sept. 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. Carlos, Luis and Jose Benitez remain fugitives.
The cases were prosecuted by Assistant Chief Hank Bond Walther and Trial Attorney John K. Neal of the Criminal Division's Fraud Section, and Trial Attorney Constantine Lizas of the Criminal Division's Asset Forfeiture and Money Laundering Section. The FBI and Department of Health and Human Services, Office of the Inspector General, investigated the cases.
The cases were brought as part of the Medicare Fraud Strike Force (MFSF), supervised by Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Since the inception of MFSF operations in 2007, federal prosecutors have indicted 104 cases with 184 defendants in 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