MEDICARE FRAUD

Tampa probe finds Medicare paid for illegal oxycodone

 

Tampa Bay Times

A Broward County man with a history of drug dealing found a novel way to front his oxycodone trade.

Medicare Part D.

Brian Francis Kelly, 53, is one of four people accused in a conspiracy to use HIV patients and a Coral Gables clinic to defraud the federal government by filing false claims for drugs and medical care through the now-defunct St. Petersburg Medicare insurer, Universal Health Care Group.

Universal filed for bankruptcy protection last year amid allegations of fraud and embezzlement, but in the latest matter, the government calls the insurer a victim of fraud.

The U.S. Attorney’s Office in Tampa unsealed indictments this week against Kelly, Gladys Fuertes, 40, Mario Fuertes, 38, and Cathleen Ortega, 55, based on an investigation by the Tampa Bay office of the Medicare Fraud Strike Force.

In a signed plea agreement, Kelly said he recruited patients for the Fuertes couple’s clinic, Gables Medical and Therapy Center, which then used the patient identities to claim reimbursements for medical treatments not provided.

The patients got kickbacks and oxycodone prescriptions, which at times were forged by the Fuerteses, the plea agreement states.

“Some patients took the oxycodone pills prescribed, while others sold the pills to Kelly for cash,” the document states. “Kelly sold the oxycodone pills to street-level users and other distributors in Florida and Pennsylvania in exchange for cash, typically between $25 to $50 per pill.”

The prescriptions were filled at a Ft. Lauderdale pharmacy, which then submitted claims for reimbursement to Universal’s Medicare Part D plan.

Medicare Part D is a federal program to subsidize the cost of prescription drugs.

It’s unclear how much government money went to oxycodone.

But the Gables clinic filed claims for treatment in excess of $1 million, of which Universal paid $266,423, Kelly’s plea agreement states. In one case, the clinic billed Universal $91,342 for a patient who received no treatment, the document states.

Kelly, originally from Massachusetts, was convicted in Broward in 2006 on charges that included possession with intent to distribute methamphetamine.

In the current federal case, he admits to a health care fraud conspiracy charge, though he has not yet formalized the plea deal with a court appearance. Ortega, in her plea, admits to making false statements to investigators.

The Fuerteses, arrested Wednesday in Miami, are charged with conspiracy, health care fraud, aggravated identity theft and obstructing a health care investigation.

Staff writer Patty Ryan can be reached at pryan@tampabay.comor (813) 226-3382.

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