FEDERAL JUDGES

Still, one Medicare fugitive in that case is still at large: Emilio R. Seijo, who is in Cuba, according to the FBI.

The escalating problem of Medicare fraud defendants who flee has become a sore point for federal judges in South Florida.

This spring, the chief judge of the U.S. District Court in Miami raised the issue in a memo to magistrate judges, cautioning them about flight risks. U.S. District Judge Federico Moreno also reviewed Medicare defendants' bonds in cases before him, citing the unusual pattern of defendants fleeing after they were charged with Medicare fraud and granted bail.

In June, Moreno said in court that ``it seems to me that our thinking has to change -- that someone from Cuba can flee back to Cuba just like someone from Mexico.''

Moreno questioned whether the Cuban Adjustment Act -- passed by Congress in 1966 to grant asylum and residency to the first wave of Cuban political refugees -- was being abused by a new generation of Medicare fraud suspects. The judge wondered aloud ``whether someone can be categorized as a political refugee when you can pick up and go back.''

Moreno raised the point after learning that a former secretary charged in an $11 million Medicare healthcare scheme fled to Cuba with her son and father.

The judge had given Carmen González a $50,000 bond. Her father, Enrique González, who co-signed it, was indicted in May on separate Medicare fraud charges in a $26.2 million HIV-drug scam at other Miami-Dade clinics.

''I don't know what your client's situation is, but money goes a lot farther in Cuba,'' the judge told Gonzalez's attorney, Joel DeFabio. ``Dollars do. And the government's allegation is that dollars are the result of Medicare fraud.''

Moreno isn't the only federal judge to be blindsided.

The case of Medicare fraud felon Gustavo Smith illustrates how easy it is for fugitives to leave the United States.

After Smith was convicted on healthcare fraud charges at trial in April, U.S. District Judge Marcia Cooke allowed him to remain free on a $300,000 bond while he awaited sentencing. Prosecutors insisted that Smith be detained. Cooke placed him on home confinement.

On June 11, Smith, who had surrendered his U.S. passport, took an American Airlines flight to Santo Domingo with his girlfriend. How? Smith used his Cuban passport under the name Gustavo Smith Wong. The FBI and Dominican authorities are tracking him down. In early July, Cooke sentenced him in absentia to 10 years and 10 months in prison.

MEDICARE OUTLAWS

One of the obvious reasons that Medicare defendants can evade prosecution is because they're routinely allowed to post bond before trial. But most of the Medicare defendants who fled since 2004 left South Florida before federal agents could arrest them, according to the FBI and prosecutors. In some cases, suspects get nervous when a colleague is arrested and flee before they can be implicated.

A typical example: Fermin Rey, 49, who emigrated from Cuba in 1995 and was indicted last year on charges of using a series of healthcare corporations to bill Medicare for $5.2 million in bogus medical equipment claims. Rey, described by authorities as a Santeria high priest who used associates as straw owners of his illegal businesses, failed to appear in court and is believed to be in Mexico.

Why do so many Cuban immigrants become Medicare fraud perpetrators? Andy Gomez, a senior fellow at the University of Miami's Institute for Cuban and Cuban-American Studies, has a theory.