FBI agents bust Miami Medicare ring while some suspects flee to Cuba

In September, a trio of FBI agents showed up at a Hialeah dental office looking for Pedro Torres.

Torres slipped away before they could arrest him as an employee created a distraction, shouting in Spanish that the suspect had run down the hallway and into the street. Torres, suspected mastermind of a 10-chain pharmacy ring that bilked Medicare for millions, escaped to Cuba — along with three others from his organization.

But on Thursday, federal agents caught up with 18 other members of his network and arrested them on charges of operating Miami-Dade pharmacies as fronts to steal $17 million from the taxpayer-funded Medicare program. Earlier, agents had arrested three other suspects in a related pharmacy case in which Medicare lost almost $10.5 million because of false claims for prescription drugs.

The fugitives in the main case are Torres, the accused ringleader; Antonio Hevia, who has a prior Medicare fraud conviction; and Mario Saul Lay and Ariel Nunez Finalet, the listed owners of two of the pharmacies. They are among an estimated 150 South Florida defendants facing Medicare fraud offenses who are at large in Cuba, Mexico and other countries.

At dawn Thursday, federal agents with the FBI and Health and Human Services fanned out to arrest the defendants, who used a string of local pharmacies to rip off millions from the U.S. government. The defendants are charged with conspiring to defraud the federal health insurance program by paying off recruiters to reel in Medicare beneficiaries so they could use their ID numbers to file false claims for prescription drugs, according to authorities.

Authorities say they pulled off the multimillion-dollar racket by forging doctors’ signatures for medication that was either unnecessary or not provided. Medicare and private insurers failed to detect the fraud after paying out millions — a longstanding problem because of lax oversight by federal healthcare regulators.

“Unfortunately, South Florida remains ground zero for these types of scams,” said William Maddalena, assistant special agent in charge of the FBI’s Miami office.

Pharmacy fraud has become increasingly commonplace in South Florida, the nation’s perennial capital of Medicare fraud. The U.S. attorney’s office has increasingly made cases against local pharmacy offenders who steal from the so-called Part D prescription drug program under Medicare.

Since its inception in 2006, the Part D program has gained popularity because it helps deliver prescription drugs to nearly 40 million elderly and disabled Americans, who buy them from pharmacies reimbursed by private insurers funded by Medicare. But predictions of potential fraud in the program — which accounts for just over 10 percent of Medicare spending — have turned out to be accurate because numerous pharmacies submit bogus prescriptions for anti-depressant, anti-inflammatory and other drugs.

In several of the latest criminal cases in Miami, pharmacy owners paid kickbacks to patients or patient recruiters to generate a steady stream of false Medicare claims and bilk the Part D program. That has been a longstanding practice in South Florida’s Medicare rackets, which have billed for a host of unused services from medical equipment to HIV infusion therapy to mental health sessions.

This story was originally published April 28, 2016 at 12:58 PM with the headline "FBI agents bust Miami Medicare ring while some suspects flee to Cuba."