September 10, 10

NEWS / Miami-area Clinic Owner Pleads Guilty in $23 Million Health Care Fraud Scheme

WASHINGTON – A Miami-area resident who owned and operated an HIV infusion clinic pleaded guilty today for her participation in a $23 million HIV infusion Medicare fraud scheme, the Departments of Justice and Health and Human Services announced today.

Flor Crisologo, 58, pleaded guilty before Magistrate Judge Barry L. Garber in U.S. District Court in Miami to one count of conspiracy to commit health care fraud. Crisologo was originally charged in a May 2010 indictment.

According to the plea documents, Crisologo was the owner and operator of J & F Community Medical Center Inc. Crisologo admitted that she submitted approximately $23 million in false and fraudulent claims to Medicare for HIV injection and infusion services purportedly provided through J & F. According to court documents, Crisologo hired a physician at J & F and conspired with the physician and others to order unnecessary tests, sign false medical analyses and diagnosis forms, and authorize treatments to make it appear that medical services were being provided to patients who were Medicare beneficiaries. The services included medically unnecessary injection and infusion therapies. Crisologo admitted that she and her conspirators paid Medicare beneficiaries kickbacks to induce the beneficiaries to claim they received legitimate services at the clinic when in fact the HIV infusion services were either not provided or were not medically necessary.

The maximum sentence for conspiracy to commit health care fraud is 10 years in prison. Crisologo also faces fines and forfeiture of any property or proceeds derived from her criminal activities. Sentencing is scheduled for Nov. 23, 2010.

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies , Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (OIG), Office of Investigations Miami office.

This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals who collectively have falsely billed the Medicare program for more than $1.85 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

http://www.justice.gov/opa/pr/2010/September/10-crm-1013.html

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