2 Miami-Dade doctors, 2 assistants convicted of Medicare fraud

A federal jury said two Miami-Dade doctors and two medical assistants filed $5.3 million in bogus Medicare claims.

By JAY WEAVER

Miami Herald--March 18, 2009

They manipulated blood samples. Falsified medical records. Wrote prescriptions for HIV patients who didn’t need their obsolete drugs.

They even tossed out the infusion medication but kept the empty bottles in case Medicare investigators ever checked out their fraudulent clinics. On Tuesday, a federal jury convicted two Miami-Dade doctors and two medical assistants of plotting to submit millions of dollars in bogus bills to Medicare — a fraud case that stands out because one defendant allegedly tried to flee near the end of the trial.

The 12-person jury found Dr. David Rothman, Dr. Keith Russell, Eda Marietta Milanes and Jorge Luis Pacheco guilty of conspiring to commit fraud and other charges for filing $5.3 million in false HIV-therapy claims with the nation’s healthcare program.

`DESPICABLE’

Medicare paid the racket’s two Miami-Dade clinics $2.5 million for HIV infusion treatments that were either medically unnecessary or never given to the patients — another sign of the government agency’s chronically lax oversight of fraudulent clinics in Miami-Dade County.

”I now know it was something despicable,” testified the owner of the clinics, Tony Marrero, who had pleaded guilty with three other defendants before trial.

Marrero testified that Rothman was paid $200,000 and Russell $40,000 for writing prescriptions for the outdated intravenous HIV therapy from 2004 to 2006. Marrero said he paid $200 kickbacks to patients for each visit to use their Medicare numbers to submit the bogus bills — including one who testified that he did not have HIV. He also said the medical assistants manipulated blood platelet levels in patient records to justify their treatments to Medicare, and that he obtained fake invoices from a drug wholesaler to show that his clinics had provided the infusion drugs to patients. He said the clinics even emptied the drug-infusion bottles to make it look like they were actually used to treat patients.

”We wanted to make it appear we were providing the services,” testified Marrero, who owned the two clinics, Medcore Group and M&P Group, with his wife, Belkis, who also pleaded guilty.

Another key player in the scheme was Pacheco, a former physician in Cuba, who allegedly tried to flee the United States on Saturday before the jury was to begin its deliberations on Monday. He was arrested in the Homestead area with $12,600 in cash and a false Florida driver’s license in the name of ”Jose Luis Falcon,” federal authorities said.

`GOING FISHING’

Before his arrest, Pacheco cut off his ankle monitor in violation of the terms of his bond, and documents seized from him contained multiple contacts in the Dominican Republic, authorities said.

Pacheco, 50, told police that he was “going fishing.”

He and the other defendants are part of a growing list of dozens of South Florida doctors and assistants convicted of billing Medicare for hundreds of millions of dollars in fraudulent claims for outdated HIV infusion therapy administered intravenously.

SIMPLE ALTERNATIVE

That therapy was replaced about 15 years ago by more-effective antiretroviral drugs taken orally, experts say, yet Medicare continues to pay for the infusion therapy because the agency still considers it “medically reasonable and necessary.”

Dr. Michael Wohlfeiler, a Miami Beach physician whose practice treats about 2,500 HIV/AIDS patients, testified that antiretroviral drugs — dubbed the ”cocktail” — has turned a rapidly terminal illness into a chronically managed disease. He questioned why Medicare would continue to foot the bill for such obsolete infusion drugs.

”Just the fact that Medicare pays for it doesn’t mean it should be the treatment,” Wohlfeiler testified. “We have regimens that are as simple as one pill a day.”

He also said the HIV infusion drugs would harm patients who already take the cocktail orally.

HOUSE ARREST

At trial, Justice Department prosecutors Jay Darden and Kirk Ogrosky showed evidence that the two Miami-Dade physicians, Rothman and Russell, had been involved in other HIV clinics that falsely billed Medicare.

They said Rothman, 66, wrote prescriptions for about $60 million in phony HIV treatments from 2004 to 2005, and that Russell, 65, also wrote prescriptions totaling millions of dollars at other clinics.

Rothman and Russell are under house arrest until their sentencing on June 26. Pacheco and Milanes, the other medical assistant, are being held at the Federal Detention Center in Miami.