South Florida Husband & Wife Plead Guilty to Health Care Fraud Conspiracy

The family business was thriving. Between late 2009 and mid 2012 Flores Home Health, a Miami based health care agency billed and were paid roughly $8 million for the care and services they provided to their patients.

Marina Sanchez Pajon, 29 and Miguel Jimenez, 43, a married couple from Dade County found success in the health care industry. They put together a top-notch sales force of patient recruiters. They also had excellent “contacts” in doctors’ offices and clinics that were paid very well for providing clientele for the couple’s enterprise.

Jimenez controlled and managed the company’s everyday activities and oversaw all aspects of its operation. His wife Maria was responsible for supervising the “employees”, and taking care of the mountain of paperwork that is customary in this type of enterprise.

Regrettably, the patient recruiters of Flores Home Health were not compensated with a typical salary structure. They were given kickbacks and bribes to steer patients to the married couple’s clinic. Once the patients were attained they would receive home health and therapy services that were therapeutically pointless and in some cases, not provided at all. Their doctors’ office “contacts” were also retained by the inducements of bribes and payoffs that would provide the couple’s firm with medical certifications, therapy prescriptions, and various other required documents. These forms and documents made it possible for them to bill their “chief purchaser” for physical and occupational therapy provided to their patients. The firm’s “chief purchaser” was Medicare.

Flores Home Health is no longer operating and the said “employees” and “contacts” are now branded as coconspirators. On May 14, 2013 Pajon and Jimenez were indicted. The indictment charged them with the crimes of conspiracy to receive and pay health care kickbacks, conspiracy to commit health care fraud, and substantive kickback charges. At the time, The Asset Forfeiture Section of the Department of Justice that prosecutes criminal and civil asset forfeiture matters, dealing with an extensive assortment of federal offenses had acquired seizure warrants and restraining orders on five vehicles and bank accounts holding $160,000. The HHS-OIG has also filed “*lis pendens” (Latin for “suit pending” see footnote) against four real properties that were acquired with profits derived from the scheme.

The indictment was brought as the result of sweeping arrests by the Medicare Fraud Strike Force which was responsible for the takedown of 24 individuals from the South Florida area in March. 89 Individuals in total were rounded up nationally for the submission of over $45 million in fabricated billings to Medicare.

On August 13, in Miami, the couple each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Ursula Ungaro in the Southern District of Florida. Sentencing is scheduled for Oct. 30. The pair is each facing a sentence of 10 years in prison as a maximum penalty.

The case was investigated by the FBI as well as the Office of Inspector General’s U.S. Department of Health and Human Services as a part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The case was just one of many where indictments were unsealed regarding investigations conducted by the M.F.S.F. The strike force is currently functioning in nine cities across the country. Since its inception it has indicted more than 1,500 defendants that have fraudulently billed Medicare more than $5 billion.

In the words of U.S. Attorney Wifredo Ferrer, “Health care fraud continues to be a drain on scarce Medicare dollars, as unscrupulous individuals insist on using the Medicare Trust Fund as their private ATMs. We are undaunted and remain committed in our resolve to help preserve and protect Medicare for those who need it, the sick, the elderly and the poor.”

U.S. Attorney General Eric Holder also commented in reference to the work done by the Strike Force “Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems…” they are “protecting the American people from all forms of health-care fraud, safeguarding taxpayer resources and ensuring the integrity of essential health-care programs.” Mr. Ferrer commended the investigative efforts of the multiple agencies involved as well as the FBI.

*As it now stands, a lis pendens is a printed announcement stating that a lawsuit has been filed in regard to real estate, which involves either the title to the property or a claimed proprietorship concern in it. A lis pendens that is recorded against a complete entity or a section of property signals a potential buyer or financier that the property’s title is presently in question.

The consequences of a conviction for health care fraud or the conspiracy to commit health care fraud can be extremely punitive. It can often include long-term incarceration, surrender of assets and costly restitution. It is critical that if an individual is charged with any of these types of allegations that they directly contact an experienced attorney, who practices in this field of law to achieve the best possible outcome.

If you, a friend or family member is in need of an experienced criminal defense attorney in the tri-county area, Mr. Cohen’s office can provide you with the skilled representation that is essential to protect your rights. He has defended many cases dealing with these types of cases and has returned the best results possible for his clients based on the situation of the offenses alleged by the prosecution.

Mr. Cohen is a board certified criminal trial lawyer rated AV by Martindale Hubbel (pre-eminent) and a “Super Lawyer” recognized as being in the top 5% of his specialized field (criminal trial law) among Florida lawyers. He is considered a specialist by the Florida Bar in his field. Mr. Cohen has tried scores of cases over his 35 year career and is a member of the Florida and New York Bars. He practices in Fort Lauderdale, West Palm Beach and Miami, among other counties. He is also admitted to practice in the United States Court of Appeals for the Eleventh and Second Circuit.

Mr. Cohen’s practice has recently expanded and he is now a partner in the prestigious law firm of McLaughlin & Stern, LLP. Through this partnership, Mr. Cohen can now lead your defense in the New York Metropolitan area in addition to the Broward, Dade, or Palm Beach County areas as well as all other jurisdictions throughout the state of Florida
Mr. Cohen is also listed in the 2013 edition of “Best Lawyers in America

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