Two Miami Residents Plead Guilty for Receiving Health Care Kickbacks

Crimes relating to the Health Care Industry are one of the most costly issues that American taxpayers are forced to endure. The FBI has estimated that crimes of this nature cost taxpayers an average of $80 billion annually. Statistics show that as little as three percent of this money is recovered and in many cases whistle blowers get paid a substantial amount of the recovered funds for their participation in bringing the offenders of these criminalities to justice.

In an article posted here on August 20, our narrative conveyed a story of a married couple who pleaded guilty to the federal charge of conspiracy to commit health care fraud. Another of the charges that was originally levied against them in the indictment was the payment of kickbacks to patient recruiters in order to direct willing patients to Flores Home Health, the couple’s health care clinic. There, the therapy services offered turned out to be curatively deceitful and in many situations, not delivered in the least, although settlement by Medicare was conveyed for the fabricated and theoretical services rendered.

Elizabeth Monteagudo, 33, and Cristobal Gonzalez, 39, didn’t work for Flores Home Health but their job description of patient recruiters fit the same type of personnel that were paid by Marina Sanchez Pajon and Miguel Jimenez the owners of Flores. Yesterday, the two Miami residents pleaded guilty to receiving kickbacks for their part in a similar federal health care fraud; this scheme in its entirety netting $48 Million.

Throughout the duration of early 2009, concluding roughly in mid-2011, Monteagudo and Gonzalez operated as patient recruiters for Caring Nurse Home Health Care Corp., soliciting and receiving kickbacks and bribes from the owners and operators of the health care company in return for allowing the agency to bill the Medicare program on behalf of the recruited patients. Gonzalez also worked for Good Quality Home Health Care, Inc. in the same capacity. Comparable to the Flores case, these Medicare recipients were subsequently billed for therapy and home health care services that were medically needless or not provided at all, according to documents presented in court.

Additionally, Monteagudo who owned and operated a company named Starlite Home Health Agency Inc. also admitted to her participation with $7 million in fraudulent Medicare billings.

In a separate case that led to these two guilty pleas, the owner/operators of Caring Nurse Home Health Care Corp. and Good Quality Home Health Care, Inc. were sentenced to serve 9 years, and a little over 4 years in prison. On Feb. 27, 2013, Rogelio Rodriguez received the longer sentence while Raymond Aday was given the lesser. These sentences were announced subsequent to their guilty pleas in December 2012. Rodriguez was the owner of the two health care companies and Aday managed both. The two pleaded guilty to one count of conspiracy to commit health care fraud which was charged in an indictment unsealed in October of last year. That indictment charged that between the period of January 2006 and June 2011, each of the two companies submitted claims in the area of $48 million for home health services that weren’t necessary medically, and in many cases not provided at all. In lieu of these falsified claims $33 million of the total amount billed was actually paid by Medicare.

According to the court documents from that case, Rodriguez and Aday colluded with patient recruiters with their ultimate goal being the illegitimate charging of Medicare for unnecessary services rendered. The documents also stated that both defendants paid bribes and kickbacks to the above-mentioned patient recruiters, as well as others.

According to the Department of Justice, nurses and office staff at both health care companies were also implicated for falsifying files of their patients in their attempt to make it seem that the Medicare beneficiaries qualified for services when they in fact did not.

In addition to the term of their incarceration, U.S. District Judge Federico A. Moreno sentenced Aday to pay $2.1 million and Rodriguez to pay $33 million in restitution. They will each also have to pay a fine of $100,000. The two were also penalized to a term of three years of supervised release at the completion of their prison terms.

Both cases were investigated by the FBI and Department of Health & Human Services-Office of the Inspector General, which was conveyed as a measure of the Medicare Fraud Strike Force.

The consequences of a conviction for 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 possible results for his clients based on the situation of the offenses alleged by the prosecution.

An attorney who previously worked as a Federal prosecutor and knows the ins and outs of the Federal system can be a great asset in planning a proper strategy no matter what issue of fraud is involved.

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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