A Medical Device Daily
The Attorney General for the State of Florida reported that defendants Mabel and Abner Diaz were each sentenced today to 14 years' incarceration for conspiracy to commit healthcare fraud and healthcare fraud. Defendant Suleidy Cano was sentenced to eleven years' incarceration for conspiracy to commit health care fraud and aggravated identity theft.
According to the parties' joint factual statement in support of the plea, the fraud involved durable medical equipment (DME), which is equipment that can be used in the home on a repeated basis for a medical purpose. Where DME is prescribed or ordered by a physician, an authorized Medicare provider who supplies the equipment to a Medicare beneficiary may be eligible for reimbursement by Medicare.
Abner Diaz and Mabel Diaz co-owned and operated All-Med Billing Corp., a Miami medical billing company, where Cano worked as a biller. All-Med submitted claims to Medicare on behalf of suppliers who purportedly provided DME to Medicare beneficiaries. All-Med submitted $419,935,692.74 in fraudulent claims for DME purportedly provided to Medicare beneficiaries by 85 DME suppliers. These claims were for equipment that had not been ordered by physicians or delivered to the beneficiaries as claimed. As a result of these claims, Medicare paid the suppliers nearly $148,586,919.99.
In other legalities:
• Staten Island University Hospital (SIUH; Staten Island, New York) has agreed to pay the United States $74,032,565 to settle claims that the hospital defrauded Medicare, Medicaid and the military's health insurance program, TRICARE, said Benton Campbell, U.S. Attorney for the Eastern District of New York and Gregory Katsas, Assistant Attorney General for the Justice Department's Civil Division. In addition, the hospital will pay the State of New York $14,883,883, representing damages sustained by the state's Medicaid Program. In total, SIUH will pay $88,916,448.
The settlement, in part, resolves suits filed on behalf of the government in the U.S. District Court for the Eastern District of New York by two individuals. Dr. Miguel Tirado, a former SIUH Director of Chemical Dependency Services, who filed suit under the federal False Claims Act and the New York State False Claims Act, alleged that the hospital had fraudulently billed Medicaid and Medicare for inpatient alcohol and substance abuse detoxification treatment. The government's investigation established that, during the period July 1, 1994 through June 30, 2000, SIUH submitted claims for payment for detoxification treatment provided to patients in beds for which SIUH had received no certificate of operation from the New York State Office of Alcoholism and Substance Abuse Services (OASAS).
Although SIUH was authorized to provide inpatient detoxification care to patients in 56 beds, it administered treatment in 12 additional beds located in a locked, separate wing and concealed the existence of the wing from OASAS. SIUH has agreed to pay the United States $11,824,056 and $14,883,883 to the state of New York according to an agreement that has been approved by U.S. District Judge Edward Korman. New York State's claim was litigated by the New York State Attorney General's Office, Medicaid Fraud Control Unit.
Elizabeth Ryan, widow of an SIUH cancer patient, asserted in her federal False Claims Act suit that SIUH fraudulently billed Medicare for stereotactic body radiosurgery treatment that was provided on an out-patient basis to cancer patients. The investigation established that from 1996 through 2004, SIUH defrauded Medicare and TRICARE by knowingly using incorrect billing codes for cancer treatment performed at the hospital. By using incorrect codes, SIUH obtained reimbursement for treatment that was not covered by Medicare or TRICARE. SIUH will pay the United States $25,022,766 to settle this claim according to an agreement that has been approved by U.S. District Judge John Gleeson.
As a result of the settlement, Tirado will receive $2.3 million from the federal government and $2.97 million from New York. Ryan will receive $3.75 million as her portion of the federal recovery. The federal False Claims Act and newly-enacted New York state False Claims Act permit private individuals to file suits on behalf of the government and receive a portion of the recovery.
The government's other two claims were resolved prior to the filing of suit. The U.S. had determined that SIUH deliberately inflated its resident count from the 1996 cost report year through the 2003 cost report year. Medicare pays a share of the cost of Graduate Medical Education at teaching hospitals such as SIUH. The amount paid is determined by Medicare annually based upon "cost reports" submitted by the hospitals. SIUH has agreed to pay the United States $35,706,754 to settle this claim.
Also, the present settlement concerns SIUH's billings to Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds during the period of July 2003 through September 2005. The hospital has agreed to pay the United States $1,478,989 to settle this claim.
The United States' investigation was led by the U.S. Attorney's Office for the Eastern District of New York.