Emilio Amador, 46 brought potential patients to two South Florida Home Health Care companies in exchange for bribes and kickbacks while fully aware that those two companies would submit all costs to Medicare on behalf of the patients he referred to them for the supposed home health services they provided. Amador was a patient recruiter. He was also the owner/operator as well as president of Nation's Best. He also pleaded guilty to relevant conduct for the fraudulent billing of approximately $30 million for his dealings associated to that company.
Earlier this month, Judge Federico Moreno sentenced Amador, to nine years in prison in U.S. District Court for the Southern District of Florida. His sentence was the result of his role in a $48 million scheme to defraud Medicare. Amador pleaded guilty to charges of two counts of receiving health care kickbacks and one count of conspiring to receive health care kickbacks this past September. Additionally at the conclusion of his stint behind bars, Amador has been ordered to a term of three years of supervised release. He has also been ordered to come up with $24 million in restitution, individually as well as jointly with other convicted co-defendants. But the $24 million in restitution is just a single drop in a very large bucket.
With Florida having the highest percentage of senior citizens in the United States with over 17%, according to the latest census report, it would be a logical conclusion to assume that health care services would also be the highest percentage in the country. It's also reasonable to assume that health care, Medicare and Medicaid fraud would go hand-in-hand based on those statistics.
On a nationwide basis estimates of monies stolen through various methods in health care Medicare and Medicaid schemes are figured to be at least 100 billion; but according to some that are in the know regarding these statistics, that number is a low estimate. Other well-informed sources believe that the actual amount of stolen funds is closer in vicinity to 300 billion dollars annually.
Investigation and enforcement also generates a hefty tab. In total, last year's costs (2012) amounted to over $217 million, broken down by the Federal government picking up over $162 million of the overall sum. There are fifty Medicaid Fraud Control Units which employ over 1,900 individuals including enforcement officers, as well as the FBI's Federal Medicare Fraud Strike Force that through June of this year has brought charges against just short of 90 medical professionals including doctors and nurses in eight cities throughout the country, with schemes relating to Medicare fraud which has totaled close to $225 million in false billings according to government records. There are currently more than 400 law enforcement officers including agents from the FBI working to make the arrests in these types of cases in Miami, New York, Detroit, Los Angeles and other major US cities.
Florida is a breeding ground for Medicare and Medicaid fraud. Overall, the cost in trying to contain, arrest, and prosecute offenders is a multi-million dollar effort with hundreds of law enforcement officers working to detect and investigate these schemes throughout the state with the ever-present assistance of federal law enforcement agencies.
In this particular case, the sentencing of Amador was a segment of a Medicare Fraud Strike Force Operation that charged twenty-four South Florida residents in fraudulent billing schemes. It was part of a nationwide sweep that arrested and charged a total of ninety-eight people.
In February of this year, the heads of two Florida Home Health Care companies were sentenced as part of the $48 Million Health Care Fraud Scheme mentioned above. Rogelio Rodriguez, 44 was the president of Caring Nurse Home Health, Corp. and Raymond Aday, 49 the president of Good Quality Home Health Care Inc. were each sentenced to nine years, and more than four years respectively for their roles in the illegal billing scam. The sentencing was imposed after guilty pleas were accepted by the two in December 2012 for the Indictment which was made public earlier in October.
The Indictment charged them with one count each of conspiracy to commit health care fraud and it displayed that between the start of January 2006 through the period ending around mid-2011 the two companies submitted approximately $48 million in claims of which Medicare paid approximately $33 million. The claims submitted were for home health services that were either not medically necessary and/or not provided at all.
In Case number 13-20315-CR-Lenard which charged five defendants including Amador, the sentencing phase is now concluded. The other four defendants named in that individual case were Cristobal Gonzalez, Eduims Mora, Jose Contreras, and Elizabeth Monteagudo. All charges related to conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks in connection with a federal health care program.
Monteagudo, 33, and Gonzalez, 39, both from Miami, were sentenced to serve 70 months and 46 months in prison respectively, followed by three years and two years of supervised release respectively. They were ordered to pay $3.5 million and $2 million in restitution respectively, jointly and severally with co-defendants. Mora and Contreras each received a 34-month prison sentence for their roles in the fraud.
To read other articles on this topic, some with the same defendants who faced other charges in different cases against them click here.