South Florida

Think Medicare fraud is slowing down? Think again

More than 300 people were arrested in raids on Wednesday. Three years ago, in an other take-down, federal agents shown here led another major raid.
More than 300 people were arrested in raids on Wednesday. Three years ago, in an other take-down, federal agents shown here led another major raid. AP File

The sheer number of suspects arrested and charged with stealing from Medicare — just over 300 nationwide, including 100 in South Florida — was one for the record books.

But Wednesday’s massive take-down of doctors, nurses, pharmacy owners, clinic operators and patient recruiters revealed that the Justice Department’s crackdown over the past decade has not exactly slowed down Medicare fraud.

Miami, as usual, accounted for the greatest number of arrests, reinforcing its reputation as the nation’s healthcare fraud capital.

The fraud simply won’t go away because “it’s easy money,” U.S. Attorney Wifredo Ferrer told the Miami Herald, noting the new South Florida cases “show the infiltration of fraud at every level of the healthcare process.”

Ferrer joined U.S. Attorney General Loretta Lynch at a news conference in Washington that spotlighted a vast array of criminal cases from Florida to Texas to California, revealing not only the endless crisis of Medicare fraud but the system's lax oversight in scrutinizing claims. The result: a long-flawed “pay and chase” model in which Medicare quickly pays bills — leaving law enforcement to pursue criminals who rip off the taxpayer-funded program for the elderly and disabled.

The offenses outlined in dozens of indictments ranged from home healthcare to prescription drug scams — totaling $900 million in bogus claims for services that were not needed or provided across the country, authorities said. Since the formation of a nationwide Medicare strike force a decade ago, the latest take-down represents the highest number of arrests and claims losses for healthcare fraud offenses.

“The wrongdoers that we pursue in these operations seek to use public funds for private enrichment,” Lynch said during the news conference. “Above all, they abuse basic bonds of trust — between doctor and patient; between pharmacist and doctor; between taxpayer and government — and pervert them to their own ends.”

Among the most notable cases in South Florida:

▪ Two doctors, Jose Avila, 58, of Hallandale, and Michael Bahrami, 60, of Golden Beach, were charged with conspiring to defraud the Medicare program and receive kickbacks in a $57 million home healthcare scheme. The doctors’ roles were critical because they signed off on patient referrals for purported home care services, such as physical therapy, according to an indictment.

▪ Carlos F. Valencia, 50, of Miami Lakes, the owner of a home healthcare agency that purportedly provided skilled nursing services, was charged with 10 others in an alleged scheme entailing kickback payments to both patient recruiters and Medicare beneficiaries. Six patients charged in the conspiracy received kickbacks ranging from $760 to $1,200 each.

▪ While not related to these cases, the U.S. Department of Health and Human Services-Office of Inspector General issued a report on Wednesday that cited home healthcare operators in South Florida and other regions that caused Medicare to make more than $10 billion in “improper payments” because of fraud, waste and abuse in the past year. About 4,500 physicians, though not named, were singled out for contributing to the government’s losses in the home healthcare field.

▪ Pharmacy owner Nereida Montejo, 65, of Miami was charged with two others for paying kickbacks to patients and using their Medicare numbers to submit $5.2 million in bogus claims for prescription drugs that had not been purchased. Montejo, who operated New Pharmacy Discount Corp., was charged with pharmacy operator Nerta Rodriguez, 73, of Miami, and patient recruiter Carlos Hernandez, 64, of Miami.

▪ In a new case, Celep Simsir, 35, and Sonsoles Simsir, 39, both of Jacksonville, were charged with conspiring to defraud TRICARE, a Defense Department health insurance program for military personnel. The brothers are accused of paying recruiters to supply TRICARE beneficiaries for their scheme. They’re also accused of paying a doctor and a physician’s assistant in South Florida in exchange for writing prescriptions for compound medications that were not medically necessary. The Simsirs submitted a total of $25.7 million in false claims, with TRICARE reimbursing $21.2 million, prosecutors said.

During the Simsirs’ arrests, federal agents seized about $344,000 in cash, seven firearms, including an AR-15 semiautomatic rifle, a Lamborghini and a Porsche. Agents later seized $2 million from them.