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Doctor and assistants sentenced in miami medicare fraud case

Posted on August 10, 2009 3:00 AM EST

Miami Medicare fraud defendants, including a doctor and two physicians assistants are on their way to federal prison for their involvement in a Medicare fraud that exceeded 11 million dollars. Dr. Keith David Russell and Jorge Luis Pacheco were responsible for billing false claims for obsolete HIV treatments that were not even provided to the patients. Russell and Pacheco were sentenced in federal court to eight years in prison and ordered to pay back 3.1 million and 2.6 million dollars, respectively, to the Medicare system. Russell's and Pacheco's Miami criminal attorneys argued on their client's behalf at the sentencing.

U.S. District Judge Ursula Ungaro also sentenced Eda Milanes, another physician's assistant to five year in federal prison and levied fines against her in the amount of 3.1 million dollars. Another Miami physician, David Rothman was convicted in the conspiracy to commit Medicare fraud. The case received notoriety back in March, 2009 because Pacheco tried to flee Miami and the United States while the trial was in progress. Rothman's sentencing is still pending.

Federal law enforcement officials are investigating a growing list of Miami doctors and physicians assistants that are committing millions of dollars of fraud against the United States Medicare system. A large number of Medicare fraud cases stem from doctors submitting claims for outdated HIV infusion therapies that are administered intravenously. This therapy was deemed obsolete 15 years ago and has since been replaced by more effective anti-retroviral drugs which are taken orally. Medicare continues to pay for the obsolete treatment is still deemed medically reasonable and necessary.

The aforementioned defendants were employed by two clinics, M&P Group of South Florida and Medcore Group. Tony Marrero owned the clinics and paid exorbitant kickbacks to Rothman ($200,000) and to Russell ($40,000) for prescribing the outdated therapies from 2004 through 2006. Marrero also paid $200.00 kickbacks to patients for each visit they made to his clinics in order to submit the fraudulent bills to Medicare. Patients testified that they never received the treatments and one even testified that he used the money to support his cocaine addiction.

Pacheco attempted to flee before the jury deliberated and was apprehended in Homestead, Florida with around $12,000 in cash and a fake Florida driver's license. Pacheco was allegedly a formerly licensed physician in Cuba.

Doctor and Assistants Jailed for Medicare Fraud, Miami Herald, August 10, 2009.
Categories: Fraud