Miami doctor and nurse convicted in $11 million fraud scheme
Healthcare Auditing Weekly, October 21, 2008
Two Miami clinicians were found guilty for participating in an $11 million HIV/AIDS infusion fraud scheme, according to a press release from the U.S. Department of Justice (DOJ).
Physician Ana Avarez-Jacinto was convicted of one count conspiracy to defraud the U.S., to submit false claims, and to pay healthcare kickbacks; one count conspiracy to commit healthcare fraud; and three counts of the submission of false claims to the Medicare program. Nurse Sandra Mateos was convicted of two conspiracy counts.
Investigators found evidence that Alvarez-Jacinto, with Mateos’ help, ordered hundreds of medically unnecessary HIV infusion treatments at Saint Jude Rehab Center, Inc. (St. Jude), where the two worked. Investigators also found that St. Jude owners Carlos and Luis Benitez brought HIV-positive Medicare patients to the clinic and gave them cash payments in exchange for allowing the clinic to bill for unnecessary treatments. In the end, the clinic billed Medicare for $11 million for unnecessary services—Medicare paid more than $8 million of those claims.
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