Miami Medical Clinic Owner Pleads Guilty to $5.3 Million Medicare Fraud

The owner and operator of two Miami medical clinics has pleaded guilty to defrauding the Medicare program in connection with a $5.3 million HIV infusion fraud scheme.The Federal Bureau of Investigation, FBI, has released information on their website that the owner of two Florida medical clinics has pleaded guilty to Medicare fraud.

Medicare is a U.S. Taxpayer supported health program,so providers who commit health care fraud are taking money out of the pockets out of every U.S. Citizen and potentially limiting the treatments available to legitimate patients.

Orlando Pascual was already in prison when seven other individuals were charged with Federal and State Medicare Fraud in October. Indicted were Juan A. Marrero aka Tony Marrero; Orlando Pascual Jr.; Belkis Marrero; Dr. David Rothman; Luz Borrego; Dr. Keith Russell; Eda Milanes; and Jorge L. Pacheco

Orlando Pascual Jr., 43, pleaded guilty on Jan. 7, 2009, to conspiracy to commit healthcare fraud before U.S. District Judge Ursula Ungaro.

Pascual admitted in his plea:

1. He co-owned two Miami clinics named Medcore Group LLC and M&P Group of South Florida Inc. The two clinics purported to specialize in the treatment of HIV-positive patients.

2. Pascual admitted that between August 2004 and November 2006 he conspired with others to submit approximately $5.3 million in fraudulent claims to Medicare.

3. He pleaded guilty to two separate schemes to launder proceeds of the health care fraud

4. The two clinics, Medcore and M&P, were operated for the purpose of defrauding Medicare.

5. Treatments for drugs, infused or injected, were not medically necessary.

6. He and others paid cash kickbacks to patients for every visit to the clinic.

7. He and others would wrote checks for cash needed to pay off patients. The checks, which appeared legitimate, were cashed by people who would cash them for a fee.

8. Most of the clinic patients were either HIV-positive or had been given a false cancer diagnoses.

9. He and others used services of other medical professionals, including physicians, a physician's assistant and phlebotomists to help facilitate the scheme.

10. Patients' blood samples ere intentionally manipulated so they appeared to need treatment, when in fact they did not. He said that tampering with blood samples was done to make the medical files appear legitimate.

Pascual is currently incarcerated for Medicare fraud involving the operation of a durable medical equipment (DME) company in Miami from 2001 to 2003. Sentencing in this case is scheduled for April 3, 2009.

His seven co-defendants in the case are scheduled for trial beginning Feb. 9, 2009, in the Southern District of Florida.

An indictment is merely a charge. Defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt.

Resources

Miami FBI Press Release

The United States Attorney's Office Southern District of Florida Press Release

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