On September 5, 2013, owners of Trust Care Health Services, Inc. (Trust Care) pled guilty in a Florida federal court to federal healthcare fraud charges. Roberto Marrero, Sandra Fernandez and Enrique Rodriguez, owned and operated Trust Care. Trust Care was a Florida corporation, incorporated in 2005 that did business as a home healthcare services business in the Miami and South Florida area. Trust Care provided home health and physical therapy services to Medicare beneficiaries.
Trust Care was an authorized Medicare provider, approved to submit claims to Medicare. The Government’s allegations of Medicare fraud were based on the Government’s contention that physical therapy and home health services were billed to Medicare but not medically necessary, or not provided, or both.
According to the indictment, the defendants and co-conspirators paid patient recruiters to provide Trust Care with patients to whom defendants sold healthcare services that were not medically necessary and/or not provided. Kickbacks and bribes were also paid to obtain for Trust Care prescriptions, medical certifications and other documents needed to facilitate the scheme. Specifically, the government alleged:
It was the purpose of the conspiracy for the defendants and their conspirators to unlawfully enrich themselves by: (1) paying and accepting kickbacks and bribes for referring Medicare beneficiaries to Trust Care so that their Medicare beneficiary numbers would serve as the bases of claims filed for home health care; and (2) submitting and causing the submission of claims to Medicare for home health services that the defendants and their conspirators purported to provide to those beneficiaries.
Indictment, para. 3.
The defendants’ alleged Medicare fraud scheme occurred during the period from March 2007 through October 2010. During this period of time, Trust Care submitted more than $20 million in health home services claims, and Medicare paid out more than $15 million in claims. Paid patient “recruiting” was part of several alleged schemes in which the defendants are alleged to have been involved, resulting in losses to the federal government of approximately $50 million.
The defendants’ sentencing is scheduled for November 12, 2013. The defendants face penalties of up to 10 years in prison. The FBI and HHS-OIG investigated the case. The case was brought by the government’s “Medicare Fraud Strike Force” and the U.S. Attorney’s Office for the Southern District of Florida. Combating Medicare fraud and other healthcare related fraud schemes remains a top priority for federal law enforcement, due in part to the need to defray the costs of health care.
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