A Medical Device Daily

Assistant Attorney General Alice Fisher of the Criminal Division and U.S. Attorney Alexander Acosta of the Southern District of Florida last week reported that the owners of five Miami-based healthcare corporations have been sentenced to prison terms.

Collectively, the five defendants filed fraudulent claims with Medicare for over $28.6 million worth of unnecessary durable medical equipment (DME) and infusion therapy.

The five, sentenced in Miami, are: Rodolfo Aenlle, sentenced to 84 months in prison; Simon Seruya, 50 months; Alberto Gourie, 51 months; William Garcia, 41 months; and Marina Ruiz, 24 months. Collectively, they also have been ordered to repay more than $13 million in restitution.

Aenlle's corporation, Direct Nursing, was found to be a fraudulent DME company that had nothing to do with providing healthcare or nursing services. During 2001 and 2003, the company submitted claims to Medicare of $2 million and co-conspirator pharmacies billed more than $205,000. Aenlle and his partners paid patients cash kickbacks and did not use any of the equipment or medicines that were paid for.

The co-conspirator pharmacies associated with Aenlle were paid over $14 million between 2000 and 2003, based on the submission of claims for medically unnecessary "compounded" aerosol medication. Aenlle entered into an arrangement with several Miami pharmacies to "compound" medicine based on prescriptions for non-commercially available medications.

Seruya pleaded guilty for involvement in two separate Medicare fraud schemes. He owned and operated Bedat Management, a fraudulent HIV infusion clinic, and Medical Respiratory Equipment, a fraudulent DME company. Between 2001 and 2004, Seruya used these companies to submit over $15.5 million in Medicare claims.

Seruya operated Bedat as an infusion clinic and paid HIV-positive Medicare patients cash kickbacks to administer unnecessary medications such as Intravenous Immune Globulin and Intravenous Rho D Immune Globulin.

Gourie was found guilty of operating Friends Medical, a fraudulent DME company that submitted Medicare claims of more than $5.4 million, between September 2004 and September 2006, for medical equipment consisting of unnecessary power wheelchairs and incontinence supplies.

Garcia was sentenced for operation of Northwest Medical Equipment, a fraudulent DME company, which between January and December 2006, submitted Medicare claims of more than $4.5 million for unnecessary wound care supplies, pressure-reducing mattresses and oxygen concentrators.

Ruiz, was sentenced for operation of Solair Medical, a DME company that submitted claims of about $980,000 between June 2006 and March 2007, for unnecessary wound care supplies.

The cases were each brought as part of the Medicare Fraud Strike Force, supervised by the Fraud Section of the Criminal Division and U.S. Attorney Acosta of the Southern District of Florida.

Fisher said that the South Florida Strike Force "has successfully prosecuted some of the most egregious cases of Medicare fraud, and the average prison sentence for these violators is now up to almost 52 months which is above the national average of 31 months, with many Strike Force defendants receiving over 10 years."

According to the Centers for Medicare and Medicaid Services, Miami-Dade County alone accounted for more paid DME claims than 44 states. Only some of the most populous states in the country including California, Texas, New York, Michigan, and Ohio, billed Medicare for more than Miami-Dade County. According to that data, an average Medicare patient in Miami-Dade County allegedly receives $6,200 worth of DME every year, whereas patients throughout the rest of the U.S. average about $1,200 per year.

Since March the strike force has indicted about 120 defendants in south Florida which have billed the Medicare program more than $400 million.

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