Detroit Clinic Owner, Doctor and Office Manager Indicted in Medicare Infusion Fraud Scheme
Clinic Manager Pleads Guilty to Participating in Conspiracy
WASHINGTON, Oct. 9 /PRNewswire-USNewswire/ — Three Miami-Dade County, Fla., residents have been indicted in connection with an alleged $2.3 million Medicare fraud scheme operated out of X-Press Center, a Detroit-area clinic that purported to specialize in providing injection and infusion therapies, Assistant Attorney General of the Criminal Division Lanny A. Breuer, U.S. Attorney for the Eastern District of Michigan Terrence Berg and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS) announced today. In addition, a former manager at X-Press Center pleaded guilty to one count of conspiracy to commit health care fraud in connection with her management of the clinic.
Juan De Oleo, 49, Rosa Genao, M.D., 50, and Ingrid Mazorra, 35, were each indicted by a grand jury in Detroit with conspiracy to commit health care fraud and five counts of substantive health care fraud. Genao and Mazorra were also charged with one count of destroying records relevant to a federal investigation. In addition, De Oleo was charged with two counts of money laundering. The superseding indictment unsealed today added De Oleo, Genao and Mazorra to a pending indictment unsealed on June 24, 2009, charging seven defendants with alleged crimes related to their involvement with X-Press Center.
According to the superseding indictment, De Oleo was a part owner of X-Press Center, Genao was a physician employed at X-Press Center, and Mazorra was the clinic’s office manager. The indictment alleges that De Oleo and his co-conspirators agreed to open a fraudulent infusion and injection therapy clinic, and to split the proceeds of fraud among themselves. According to the indictment, Medicare beneficiaries received kickbacks in return for visiting the clinic and signing forms indicating that they received treatments that were medically unnecessary or never provided. The indictment also alleges that Genao and Mazorra altered, falsified and destroyed patient records to attempt to justify the medically unnecessary services that were purportedly being provided at the clinic.
The indictment alleges that De Oleo, Genao, Mazorra and their co-conspirators caused approximately $2.3 million in fraudulent billing to the Medicare program for services at X-Press Center that were medically unnecessary or never provided.
The charges of health care conspiracy and health care fraud carry a maximum sentence of 10 years in prison and a $250,000 fine, per count. The charge of destroying records carries a maximum sentence of 20 years in prison and a $250,000 fine. The money laundering charges carry a maximum penalty of 10 years in prison and a $500,000 fine, per count.
An indictment is merely a charge and defendants are presumed innocent until proven guilty.
Also today, Dulce Briceno, 57, pleaded guilty before U.S. District Judge Ursula Ungaro in the Southern District of Florida to one count of conspiracy to commit health care fraud. In pleading guilty, Briceno admitted that in approximately September 2006, she agreed to manage the clinic on a day-to-day basis in exchange for a percentage of the profits the clinic generated. Briceno admitted that during the time the clinic was open, the clinic routinely billed the Medicare program for services that were medically unnecessary or were never provided. Briceno admitted that she and her co-conspirators at the clinic had purchased only a small fraction of the medications that the clinic billed the Medicare program for providing.
Briceno admitted that Medicare beneficiaries were not referred to X-press Center by their primary care physicians, or for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for those kickbacks, Briceno admitted that the Medicare beneficiaries would visit the clinic and sign documents indicating that they had received the services billed to Medicare. According to court documents, kickbacks paid to Medicare beneficiaries at the clinic were made in the form of cash and prescriptions for narcotic drugs.
Briceno also admitted that between approximately September 2006 and March 2007, she and her co-conspirators at X-Press Center caused the submission of approximately $2.3 million in false and fraudulent claims to the Medicare program for services purportedly provided at X-Press Center. Medicare paid approximately $1.8 million on those claims.
At her sentencing, scheduled for Jan. 15, 2010, Briceno faces a maximum of 10 years in prison and a $250,000 fine. Briceno was originally charged in the Eastern District of Michigan, but after her arrest in Miami, she consented to have her case transferred to the Southern District of Florida for her plea and sentence.
The cases are being prosecuted by Trial Attorneys John K. Neal and Benjamin D. Singer of the Criminal Division’s Fraud Section. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The cases were brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since their inception in March 2007, Strike Force operations in four districts have obtained indictments of 300 individuals who collectively have falsely billed the Medicare program for more than $680 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
SOURCE U.S. Department of Justice