Fines, Prison for Medicare Fraud

MIAMI—After two whistle-blowers accused a Miami clinic of giving kickbacks to doctors for referring patients, the Department of Justice (DOJ) settled the case with $3 million, it announced on June 9.

Midtown Imaging LLC, a radiology clinic, and its former owners Midtown Imaging PA and PBC Medical Imaging were sued for violating the False Claims Act from 2000 to 2008.

The West Palm Beach clinic in Florida was alleged to have submitted false claims to Medicare from 2000 to 2008 by entering into agreements with referring physicians and associated groups that violated the Anti-Kickback Statute and Stark Law.

Whistle-blowers may receive part of the settlements arranged under the laws. Dr. Teresa M. Cortinas and Dr. Walter E. Wojcicki, who worked at the clinic and reported the alleged kickbacks, will get $600,000 of the settlement.

The federal government has intensified its efforts to recover money lost to Medicare fraud.

“We are deeply satisfied with today’s settlement and encourage potential whistle-blowers to come forward with evidence of wrongdoing affecting the Medicare program,” said Wifredo Ferrer, U.S. attorney for the Southern District of Florida in a press release. “We are committed to fighting fraud and abuse to help preserve scarce Medicare funds for those who need it the most, the sick, and the elderly.”

The Anti-Kickback Statute prohibits the referral of services covered by Medicare, Medicaid, or other federally funded programs in exchange for remuneration of any kind.

Earlier in the week, the DOJ announced the sentencing of Miami resident Reynel Betancourt, 51, to 77 months in prison for his participation in a $9 million Medicare fraud scheme in Detroit.

Bentancourt pled guilty March 29 to conspiring to commit health care fraud and money laundering.

Around March of 2006, Bentancourt entered into an agreement with Dearborn Medical Rehabilitation Center (DMRC) to recruit patients to provide infusion and injection therapy services to Medicare patients. He said he paid patients to sign paperwork acknowledging the receipt of injection therapy services and specialty medications that they did not receive.

DMRC billed the Medicare program for more than $9 million of services rendered, which Bentancourt admitted were false. He created two shell companies to hide his fraudulent earnings, according to his plea.

The Department of Health and Human Service Centers (HHS) for Medicare and Medicaid Services and the HHS-Office of Inspector (OIG) are working to recover money from and punish fraudulent health services providers.

These recent actions against fraud are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative announced by Attorney General Eric Holder and Kathleen Sebelius, secretary of the HHS, in May 2009. The DOJ has recovered more than $5.7 billion since January 2009 in cases involving fraud against federal health care programs.

The total recoveries in False Claims Act cases since January 2009 amount to more than $7.3 billion, according to the DOJ.