Three Miami-Area Medical Professionals Each Sentenced to Prison for Roles in $23 Million Medicare Fraud Scheme

WASHINGTON – Two Miami-area medical assistants and a physician assistant were sentenced to prison today for their roles in a $23 million Medicare fraud scheme involving HIV infusion therapy, announced the Departments of Justice and Health and Human Services.

Jose Diaz, a 62-year old physician assistant, Lisandra Aguilera, a 40-year old medical assistant, and Estrella Rodriguez, a 43-year old medical assistant, were sentenced by U.S. District Judge Joan A. Lenard to 54 months, 70 months and 57 months in prison, respectively. The defendants each previously pleaded guilty to one count of conspiracy to commit health care fraud for their roles in an HIV infusion fraud scheme.

According to court documents, Diaz, Aguilera and Rodriguez each worked at Metro Med of Hialeah Corp. (Metro Med). In 2003, Metro Med began operating as an HIV infusion clinic that purportedly provided injection and infusion therapies to HIV positive Medicare beneficiaries. In fact, the injection and infusion therapies were medically unnecessary and not provided. Metro Med paid cash kickback payments to Medicare beneficiaries in exchange for those beneficiaries allowing Metro Med to use their Medicare numbers to bill Medicare.

According to court documents, Diaz worked at Metro Med as a physician assistant and instructed Damaris Oliva, the owner of Metro Med, which medications and in what amounts to bill Medicare. Diaz provided these instructions to Oliva to ensure that Metro Med received the maximum reimbursement from Medicare, even though the injection and infusion drugs Metro Med billed to Medicare were not actually provided to the patients. Aguilera was hired by Oliva and worked at Metro Med as an infusionist. Rodriguez also worked at Metro Med as a medical assistant.

While at Metro Med, Diaz, Aguilera and Rodriguez falsified patient files to indicate that injection and infusion treatments were medically necessary, when, in fact, they were not. According to court documents, Aguilera and Rodriguez signed medical records indicating that injection and infusion treatments were provided to Metro Med patients, when, in fact, they were not. Aguilera and Rodriguez also fabricated medical records to show that Metro Med patients had received specific dosages of medications, when the patients had not actually received the treatments or medications reflected on those documents. Aguilera manipulated patient blood samples to make it appear that unnecessary injection and infusion treatments were medically necessary. Diaz, Aguilera and Rodriguez also were aware that beneficiaries who attended the clinic were being paid kickbacks in exchange for allowing Metro Med to bill Medicare under their Medicare numbers for injection and infusion treatments.

From approximately April 2003 through October 2005, Metro Med submitted approximately $23 million in claims to the Medicare program for injection and infusion treatments for Medicare beneficiaries that were not medically necessary, and not provided. The Medicare program paid approximately $11.7 million in claims.

Diaz, Aguilera and Rodriguez were charged in a July 2010 indictment, along with Oliva and Dr. Rene De Los Rios. All five defendants now have pleaded guilty or been convicted at trial. Oliva was sentenced in December 2010 to 82 months in prison.

Today’s prison sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s 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 (HHS-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, and 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 Miami.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants and organizations that collectively have billed the Medicare program for more than $2.3 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.