A Medical Device Daily

The owner of a Miami-based Medicare billing company has been charged with submitting $170 million worth of fraudulent bills to the Medicare program, Assistant Attorney General Alice Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida reported.

Rita Campos Ramirez, owner of a Medicare billing company called R and I Medical Billing (Miami) was charged in a two-count criminal information with conspiracy to commit healthcare fraud and submission of false claims to the Medicare program, stemming from a scheme to defraud Medicare of $170 million. The information also seeks forfeiture.

As charged, from October 2002 through April 2006, Campos was employed as a medical biller for about 75 Miami-based health clinics that purported to provide HIV infusion services to Medicare-eligible beneficiaries.

As part of the scheme, HIV clinic owners would provide Campos with bills stating that HIV patients were being infused with expensive HIV medications in amounts that Campos knew were medically impossible. In most instances, the Medicare program was being billed for the same HIV medications and services at each of the 75 HIV clinics. During the approximately three-and-a-half year conspiracy, Campos submitted $170 million in fraudulent medical bills to the U.S. Department of Health and Human Services on behalf of the 75 HIV clinics. Of the $170 million in fraudulent bills submitted by Campos, about $105 million was paid to the HIV clinics. Campos received a fee of about 5% of all claims paid by Medicare.

The charge of conspiracy to commit healthcare fraud carries a maximum penalty of 10 years in prison, and the charge of submitting false claims to the Medicare program carries a maximum penalty of five years in prison. Campos has agreed to plead guilty to the charges, and a plea agreement was filed today in U.S. District Court in the Southern District of Florida. A plea hearing will be held at a later date.

The prosecution resulted from the establishment of the Medicare Fraud Strike Force, a multi-agency team of federal, state and local investigators in south Florida designed specifically to combat Medicare fraud in south Florida. The Strike Force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section and the office of U.S. Attorney R. Alexander Acosta of the Southern District of Florida. Each team has four to six agents, at least one agent from the FBI and HHS Office of the Inspector General, as well as representatives from local law enforcement.

In other court news: A company and its owner are banned from selling weight-loss patches in the future and will pay $180,000 to settle Federal Trade Commission (FTC) charges that advertising claims for their weight-loss patches were false and unsubstantiated.

According to the FTC, Transdermal Products International Marketing and William Newbauer sold a supposed weight-loss patch to about two dozen domestic and foreign retailers, and provided them with sample deceptive advertising and bogus substantiation materials, including purported expert endorsements and clinical studies of their weight-loss patch by Marvin Kaplan. The retailers in turn used these materials to sell the weight-loss patches to consumers in the U.S. and abroad. The sample advertising made false or unsubstantiated claims about the product, including that it caused weight loss and that the main ingredient, sea kelp, had been approved by the FDA for weight loss.