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Two Doctors and Two Medical Assistants Plead Guilty in $10 Million Medicare Fraud Scheme

March 23, 2009 | Healthcare Finance News Staff
Source: Healthcare Finance News
WASHINGTON – Four Miami-area residents pleaded guilty today in connection with a $10 million Medicare fraud scheme involving HIV infusion clinics, Acting Assistant Attorney General

Rita M. Glavin of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.Dr.

Roberto Rodriguez , 54; Dr. Carlos Garrido , 69; Gonzalo Nodarse , 38; and Alexis Carrazana , 41; all pleaded guilty before U.S. District Judge Paul C. Huck to one count of conspiracy to commit health care fraud. All four defendants admitted to working at Midway Medical Center Inc. (Midway), a Miami clinic that purported to specialize in the treatment of HIV patients.According to the plea documents, Rodriguez was a co-owner of and practicing physician at Midway. Rodriguez admitted that he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and, in many instances, never provided. Rodriguez admitted to purchasing only a small fraction of the medication that was purportedly being administered to Midway’s patients.

Most of the services provided to patients at Midway were billed to the Medicare program as treatments for a diagnosis of thrombocytopenia, a disorder involving a low count of platelets in the blood. According to the plea documents, none of Midway’s patients actually had low blood platelet counts. Rodriguez admitted that to make it appear that the patients actually had low platelet levels, he and his co-conspirators used chemists to manipulate the blood samples drawn from Midway’s patients before the blood was sent to a laboratory for analysis. In his plea, Rodriguez admitted to ordering that patients at Midway receive medications to treat thrombocytopenia despite knowing that the laboratory results had been falsified and the patients did not actually have that condition.

Midway was not the only clinic where Rodriguez purported to treat HIV patients with injection and infusion therapies. In his plea, Rodriguez admitted that he was listed as a medical director and practicing physician for five other Miami-area HIV infusion clinics between approximately October 2003 and February 2005, where he engaged in similar misconduct. Specifically, Rodriguez admitted he and his co-conspirators billed the Medicare program for HIV injection and infusion services that Rodriguez knew were medically unnecessary and, in some instances, never actually provided. Rodriguez admitted to causing more than $20 million in false claims to be submitted to the Medicare program at all of his clinics, including Midway.

Like Rodriguez, Garrido was a part-owner and practicing physician at Midway. In his plea, Garrido admitted that he and his co-conspirators routinely billed the Medicare program for services that were medically unnecessary and, in many instances, never provided. Garrido admitted to purchasing only a small fraction of the medication that was purportedly being administered to Midway’s patients. Garrido ordered that patients be treated with medications he knew they did not need and that, in many instances, he knew the clinic did not have available to provide to the patients. Garrido admitted to working at Midway for approximately eight months before the clinic closed, during which time he admitted to submitting more than $1 million in fraudulent claims to the Medicare program.

Nodarse and Carrazana worked at Midway as medical assistants. In their pleas, the two assistants admitted to making false entries in medical records indicating that they had provided medications on particular dates and in particular dosages to patients, when, in fact, they had not provided medications. The medical assistants also admitted to being fully aware that blood samples drawn from Midway’s patients were tainted to make it appear that the patients had conditions they did not have. Both assistants admitted to administering medications to patients that they knew the patients did not need. Nodarse, who worked at Midway throughout its existence, admitted to conspiring to submit more than $10 million in false and fraudulent claims for HIV infusion services allegedly provided at the clinic.

The case is being prosecuted by Trial Attorney

John K. Neal of the Criminal Division’s Fraud Section. The FBI and the Department of Health and Human Services, Office of Inspector General, conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force (MFSF), supervised by Deputy Chief Kirk Ogrosky of the Criminal Division’s Fraud Section and U.S. Attorney Acosta of the Southern District of Florida. Since the inception of MFSF operations, federal prosecutors have indicted 106 cases with 192 defendants in both Los Angeles and Miami. Collectively, these defendants fraudulently billed the Medicare program for more than half a billion dollars.

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From Advance LPNs


Conducting background checks on prospective nurses is a lot like the so-called War on Terror’s search for “evil-doers.”  In nearly every case, the individual comes up clean, with his or her academic records, licensing and other credentials in perfect order. And, even when they don’t, the problems are often minor issues that needn’t prevent the person from being hired.

On the other hand, some background issues are serious. But both the nursing shortage and fear of lawsuits create pressures that could result in patients being exposed to such individuals. In addition, background checks aren’t designed to detect all threats.

Worst Nightmare

Nurse recruiters’ worst nightmare may be Charles Cullen, a 43-year-old registered nurse arrested in New Jersey in December for allegedly murdering a 68-year-old Roman Catholic priest with an unauthorized injection of the heart drug digoxin. Cullen, who is also accused of attempting to kill another patient at the Somerset Medical Center this past June, told authorities after his arrest that he had killed up to 40 seriously ill patients to alleviate their suffering during his 16-year nursing career.

According to the Newark Star-Ledger, Cullen began killing patients when he worked at Saint Barnabas Medical Center in Livingston, NJ, which hired him in 1987. He was subsequently hired by nine other institutions, including Somerset, despite having been fired or forced to resign, from at least three facilities. He was also convicted of criminal trespassing and harassment after breaking into the home of a female colleague with whom he was infatuated. Despite these issues, no complaints about his character or competence were ever reported to nurse licensing boards in New Jersey or Pennsylvania.

Passing the Buck

According to recruiter Loney Moses RN, too many healthcare employers are willing to pass along problem employees to other organizations.

“A lot of hospitals won’t give the reason for termination,” said Moses, who hires approximately a hundred nurses annually for Community Hospital of New Port Richey (FL). “We just get their dates of employment.” As a result, recruiters often have nothing but their intuition to distinguish between top performers and walking disasters.

Cullen is also under investigation for involvement in the 1993 death of a 91-year-old breast-cancer patient who claimed before dying that he had injected her with an unknown medication. Tests were conducted on the woman’s body for up to a hundred different lethal compounds but not digoxin. Cullen was never charged in the incident.

Double Checks

Community Hospital of Port Richey uses an outside agency to investigate applicants’ employment history, education and professional licensing. The agency also searches the individual’s history criminal convictions, including a listing in a registry of violent sexual offenders or a new federal database of suspected terrorists. Social Security records are checked to verify that the person’s identity is as represented.

“It’s a fairly thorough search,” said Moses. “We get an eight-page document. Plus, when the candidate comes in, we ask for a photo ID. Then, I personally go online to verify licensure with the Florida board of nursing.”

And yet, as even Moses conceded, even such scrupulous checking won’t turn up problems if they are not recorded.

According to another Florida recruiter, staff shortages often create pressure to take short cuts to get nurses on staff as soon as possible. It is common, she said, for institutions to allow nurses to begin work before their background checks are complete.

“Every institution needs to have a firm credentialing process in place that must be adhered to no matter what,” said Deborah L. Steven, RN, BC, CAN, vice president of Physician Services InPhyNet Hospital Services, Tampa, FL. “It is like preventive medicine. InPhyNet recruits physicians and mid-level providers (physician assistants, nurse practitioners) but uses a similar series of background checks. Steven is a former nurse recruiter.

Even at the physician level, she said, it is not unheard of to discover individuals who have misrepresented their credentials. “I can absolutely appreciate the staffing crisis that everyone is in,” she said, “and fact-checking everyone’s resume is very detailed and tedious work. But it has to be done because there are folks who will fudge.”

Some problems are financial, she said. Billing, for instance, is often linked to the credentials of the professionals who perform certain services. If an individual is not properly credentialed, insurers will not pay a bill for those services.

Other issues are strictly ethical. Steven, for instance, believes that healthcare institutions should – for the sake of patients and the industry – be more forthcoming about workers with problematic histories.

“The key question to ask may be whether the person is eligible for rehire,” said Steven. She considers the lack of a firm “yes” to that question a significant red flag.

The Outcome

After Cullen’s revelations, legislation may be on the way that would make it easier for healthcare organizations to gather such information. In Trenton, a bill was proposed in January to require that healthcare facilities report any accidents or misconduct to the state Department of Health and Senior Services. In addition, it would grant protection from retribution against those reporting errors.

Introduced late, the bill was not passed before the Jan. 12 end of the legislative session. But it was considered certain to be reintroduced. “This bill is not going to go away,” said one supporter. “This bill is going to be passed.”

In addition, New Jersey’s U.S. Senators, Jon Corzine and Frank Lautenberg, have both spoken out for a system to track license actions taken against nurses.

Mark E. Dixon is a frequent contributor to ADVANCE.

Copyright ©2009 Merion Publications
2900 Horizon Drive, King of Prussia, PA 19406 • 800-355-5627
Publishers of ADVANCE Newsmagazines
www.advanceweb.com

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One Comment leave one →
  1. April 19, 2009 9:18 pm

    Read ProPublica.org

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