April 7, 10

NEWS / Six Miami Residents Charged in $13 Million Health Care Fraud Scheme

Six Miami-area residents have been charged for their alleged role in a $13.6 million health care fraud scheme involving a Miami-area HIV infusion clinic, announced the Departments of Justice and Health and Human Services (HHS).

In a 16-count indictment returned on March 30, 2010, and unsealed today, the six defendants are charged with conspiring to submit $13.6 million in false and fraudulent claims to the Medicare program for HIV infusion services that were allegedly provided at T & R Rehabilitation Clinic (T&R Rehab) in Miami. Modesto De La Vega, 58; Rolando Nogueira, 48; Joaquin Vega, M.D., 73; Gladis Badia, 39; Jose Nogueira, aka "Tony Nogueira," 52; and Victoria De La Vega, 59, were each charged with one count of conspiracy to defraud the United States, to cause the submission of false claims and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program. In addition, Modesto De La Vega and Rolando Nogueira were each charged with one count of conspiracy to launder the proceeds of their crimes and multiple money laundering counts.

Modesto De La Vega, Dr. Joaquin Vega, Gladis Badia and Victoria De La Vega were taken into custody this morning and will make their initial appearances today at 2:00 p.m., before U.S. Magistrate Judge Stephen T. Brown. Ronald and Jose Nogueira are considered fugitives.

According to the indictment, Rolando Nogueira owned and operated T & R Rehab while Modesto De La Vega was the operator of T & R Rehab’s HIV infusion practice. The indictment alleges that Rolando Nogueira and Modesto De La Vega billed the Medicare program for HIV infusion therapy services that were medically unnecessary and were never provided. In addition, Modesto and Victoria De La Vega allegedly paid kickbacks to Medicare beneficiaries to induce them to sign logs at T & R Rehab stating that they had received the treatments that were billed to Medicare when, in fact, they had not. The indictment also alleges that Jose Nogueira managed T&R Rehab’s fraudulent HIV infusion operation.

The indictment alleges that Dr. Joaquin Vega maintained a Medicare provider number at T & R Rehab to submit Medicare claims for the medically unnecessary infusion treatments. Gladis Badia, a medical assistant at T & R, is alleged to have prepared the required documentation to make it appear that the injection and infusion treatments billed by T & R Rehab were medically necessary and provided when, in fact, they were not.

The charge of conspiracy to defraud the United States, to cause the submission of false claims, and to pay health care kickbacks carries a maximum sentence of five years in prison. The charges of conspiracy to commit health care fraud, conspiracy to engage in money laundering and money laundering each carry a maximum sentence of 10 years in prison. The charge of submitting false claims to the Medicare program carries a maximum penalty of five years in prison per count.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

Today’s indictment was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Jeffrey H. Sloman for the Southern District of Florida; Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the Miami Regional Office of the HHS Office of Inspector General (OIG).

The case is being prosecuted by Trial Attorneys Michael D. Padula and N. Nathan Dimock of the Criminal Division’s Fraud Section. The case is being investigated by the FBI and HHS-OIG. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for approximately $1.1 billion. In addition, HHS’s 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/April/10-crm-376.html

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