The HIV infusion schemes have multiplied so wildly that the Centers for Medicare and Medicaid Services, which manages the program, started to develop computer software in 2006 to block invalid HIV infusion bills in South Florida. But clever billing companies were still able to get around the barriers by submitting valid codes for false claims.
Despite more regulatory scrutiny -- and heightened criminal prosecutions -- the U.S. government's battle against South Florida clinics is far from over.
Not only do illegitimate infusion clinics continue to dot the medical landscape by the hundreds, authorities say there's also no shortage of professional HIV/AIDS patients -- especially in the inner city. There, brokers recruit mostly HIV-positive men to provide their Medicare numbers to scores of healthcare clinics in business sections of Miami, Doral and Hialeah, according to the FBI and court records.
Here's how the scam works:
Recruiters arrange for patients to take blood tests at the clinics, which have staff on site, to establish that they are HIV-positive or have full-blown AIDS. With that written designation, the patients can qualify for Medicare services, and the clinic operators can bill for bogus intravenous treatments.
The clinic operators make a fortune by prescribing costly HIV/AIDS drug infusions such as immuneoglobulin, billing Medicare for each bogus treatment. The patients sign paperwork saying they receive the treatments. In turn, the clinics pay the patients kickbacks, according to the FBI.
Clinic owners also pay bribes to physicians for each drug-infusion prescription.
Prosecutors cite a recent suspect, Dr. Ronald E. Harris, who was among the 90 doctors whose names appeared on prescriptions for McCray's bogus HIV intravenous therapy.
In late May, Harris and partner Enrique Gonzalez were charged with submitting about $26.2 million in fake Medicare claims for HIV/AIDS infusion services at their clinics, Physicians Med-Care of Miami, and Physicians Health Med-Care of Hallandale Beach, between August 2002 and February 2004.
Harris and Gonzalez were also charged with laundering at least $3.4 million in Medicare payments through ''sham'' investment and management companies -- including Caribbean Investments and Allstar Medical.
Harris, 57, is already in prison on a separate prescription-drug conviction, but Gonzalez, 62, is a fugitive. Authorities believe Gonzalez, along with his daughter, Carmen Gonzalez, fled to Cuba, according to court records.
The daughter faces Medicare fraud charges in a separate case.
Harris' attorney, assistant federal public defender Jan Smith, declined to comment.
While Harris has been in
prison, a medical biller at the center of a sprawling HIV drug infusion investigation snitched on him about his other alleged Medicare offenses, authorities said.
Her name: Rita Campos Ramirez, a 60-year-old high school dropout with a laptop computer on overdrive. Hers is the largest single case of fraud in Medicare history.
She electronically submitted some 140,000 bogus Medicare bills totaling $170 million for about 75 HIV infusion therapy clinics in Miami-Dade between 2002 and 2006, according to court records.
Among the worst offenders: Saint Jude Rehab Center, 330 SW 27th Ave., Miami, which was owned by the Benitez brothers, who were indicted in May but fled to Cuba, according to the FBI.
In April, Campos was sentenced to 10 years in prison and ordered to pay $105 million in restitution to Health and Human Services.
Campos, who personally received $5 million for her work on behalf of the HIV-drug clinics, had to forfeit $1.5 million in personal assets -- a Kendall home, a Miami Beach condo and a Brickell Avenue apartment, along with her 2004 Mercedes-Benz. She has helped prosecutors indict more than a dozen doctors and clinic operators during the past year.
'When federal agents interview physicians who are on the bills, they all initially give us the same answer: `I don't know anything about this.' On rare occasion, that is the truth,'' Ogrosky, the federal prosecutor, said at the ABA conference in May.
''The reality is that most doctors we talk to are involved and ultimately will get charged,'' he said.