Physician Sentenced to 20 Years for Medicare Fraud

New American ^ | 8-6-11 | Bob Adelmann

[Mikey_1962]

The case brought by the Department of Justice against Dr. Rene de los Rios of Miami, Florida, succeeded not only in sending the physician to jail for 20 years for systematically defrauding Medicare, but also in exposing the dark underside of the entire Medicare system itself. The sentence meted out by U.S. District Judge Joan Lenard was the second most severe sentence handed out to any doctor in South Florida, known as the “epicenter” of Medicare fraud. The dubious honor of the most severe sentence is held by Dr. Ana Alvarez-Jacinto, who was convicted of Medicare fraud in 2008 and is now serving 30 years behind bars.

Dr. de los Rios learned the Medicare scam from the owner of Metro Med, a medical clinic that specialized in HIV therapy. The owner, Damaris Oliva, who is serving his own seven-year sentence, learned the trade from three brothers — Carlos, Luis, and Jose Benitez — who owned 11 HIV clinics in the Miami-Dade area that specialized in HIV treatments and injections. The brothers billed Medicare $119 million and were reimbursed $84 million. To avoid prosecution, the brothers fled to the Dominican Republic and then to Cuba where, according to the FBI, they are in jail on immigration violations.

The scam was simple, and consisted of three coordinated strategies: phantom billing (billing for procedures that either never performed or were unnecessary), patient billing (a patient receives a kickback for allowing use of his Medicare card and then testifying that the procedure was performed), and upcoding (where bills are inflated by using a billing code that maximizes reimbursement from Medicare). The good doctor signed off on treatments that were never performed, ordered tests that were unnecessary, and ordered injections of expensive drugs — for which he was paid $3,000 a week by Oliva.

[Mikey_1962]

Wow I posted this about a year ago. Thanks for reminding me.