It was a textbook operation for veterans of law enforcement’s endless war on Medicare fraud in South Florida: 50 suspects busted over two days on charges of trying to steal almost $66 million from the federal program.
But this take-down was different from so many others in the past: 37 of those arrested were patient recruiters accused of collecting thousands of dollars in bribes for supplying Medicare beneficiaries to crooked home healthcare agencies, mental health clinics and pharmacies.
On Tuesday, U.S. Attorney Wifredo Ferrer condemned the “pay to play culture” that he said fuels the nation’s capital of Medicare fraud with “kickbacks.” He said the underground business of patient recruiting has become so competitive that brokers are demanding increasingly higher prices for patients, who also receive bribes in exchange for their valuable Medicare cards.
Ferrer said the accused all used the taxpayer-funded Medicare program “like an ATM machine,” robbing the elderly and disabled of costly services. “And they all had one thing in common: greed.”
As in the past, South Florida’s arrests accounted for the majority of Medicare fraud suspects busted in a coordinated nationwide take-down. In total, 90 doctors, nurses, clinic operators, patient recruiters and patients were charged with collectively filing $260 million in false Medicare claims.
David A. O’Neil, the Justice Department’s acting assistant attorney general of the criminal division, credited the Medicare fraud strike forces with the arrests in Miami and five other cities. The first strike force was launched in 2007 in South Florida, which has seen a “dramatic decline” in fraudulent Medicare billing activity because of crackdowns on home healthcare agencies and mental health centers, O’Neil and other federal authorities said.
In Miami-Dade and Broward counties, agents with the FBI and Health and Human Services targeted operators of home healthcare agencies, mental health centers and pharmacies -- along with their patient recruiters. In total, 26 investigations led to the two-day take-down in South Florida.
“They were trusted by patients with their well-being; instead, these medical professionals broke the law for financial gain,” said Miami’s FBI special agent in charge, George Piro.
Among those arrested in Miami-Dade:
* Yulianela Martinez, 32, Luisa Cladera, 53, Leyma Sosa, 39, and Miguel Delgado, 41, all of Hialeah, were charged with conspiring to pay kickbacks to patient recruiters who delivered Medicare beneficiaries to their company, MCDS Home Health Group. The company claimed it provided nursing, physical therapy and other care to home-bound patients who did not need or receive the services.
* Guillermo Delgado, 42, and Gabriel Delgado, 41, both of Miami, were charged with receiving kickbacks in exchange for supplying Medicare patients from assisted-living facilities to home healthcare agencies, mental health centers and pharmacies. The brothers also are accused of conspiring with Jose Morales, owner of Morales Pharmacies, in a money-laundering scheme. Morales pleaded guilty in 2012.
The most prominent name among South Florida’s newly arrested Medicare fraud suspects belonged to Dr. Barry Kaplowitz.
The Aventura psychiatrist served as the medical director of an outpatient mental health facility in Hollywood that federal prosecutors say generated $7.5 million in false claims for Medicare patients who did not need psychiatric treatment.
On Tuesday, Magistrate Judge Patrick White ordered that the former Hollywood Pavilion doctor be detained before trial, saying he was a flight risk.
“I think it’s worse for a doctor to be involved in healthcare fraud,” White declared Monday, when he first considered Kaplowitz’s bond. “It’s outrageous.”
Kaplowitz’s defense attorney, Brian Bieber, claimed the doctor was paid only $1,250 a month for his part-time services over the course of four years at Hollywood Pavilion. He later described him as a “well-respected” psychiatrist who has properly treated thousands of patients.
Kaplowitz, 53, was arrested along with Hollywood Pavilion’s former chief operating officer, Christopher Gabel, and an administrator responsible for admitting patients to HP’s inpatient facility, Melvin Hunter. Also charged was Tiffany Foster, a patient recruiter from Alabama.
Gabel, Hunter and Foster were charged with conspiring to pay or receive kickbacks for delivering Medicare patients to Hollywood Pavilion.
Justice Department prosecutor Nicholas Surmacz charged Kaplowitz, Gabel and Hunter with conspiring to commit healthcare fraud, wire fraud and related offenses.
On Tuesday, the magistrate judge also ordered that Gabel, 61, of Davie, be detained before trial, saying he was a flight risk.
Their arrests followed last year’s conviction of Hollywood Pavilion’s chief executive officer, Karen Kallen-Zury, who was found guilty along with three other employees of conspiring to bilk $67 million from Medicare by filing phony claims for mental health services from 2003 to 2012. Medicare was duped into paying $40 million to Hollywood Pavilion, which operated an inpatient hospital and outpatient program.