A Medical Device Daily

The owner of MV Research (Miami), a durable medical equipment (DME) company has pled guilty to submitting more than $2 million worth of fraudulent bills to the Medicare program, reported Assistant Attorney General Alice Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

Lazaro Uvina Salazar entered the plea before U.S. District Judge Alan Gold of the U.S. District Court in the Southern District of Florida. Uvina pleaded guilty to one count of engaging in a scheme to defraud Medicare.

Uvina admitted that from January 2007 through March 2007, he submitted about $2.2 million worth of claims to the Medicare program for equipment that was never actually provided to Medicare beneficiaries. Those $2.2 million in claims falsely represented that the equipment had been necessary and had actually been provided to Medicare beneficiaries. Uvina’s scheme involved obtaining Medicare numbers for about 250 Medicare beneficiaries, obtaining Medicare provider numbers for about 10 doctors, and submitting roughly 4,000 claims to Medicare.

Uvina faces a maximum sentence of 10 years in prison. Sentencing is scheduled for Sept. 27, 2007, before Judge Gold.

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 through the use of real-time Medicare billing data.

In other legalities: The owner of a Florida pharmacy has been convicted by a federal jury in Miami of Medicare fraud. After a five-day trial at federal court in Miami, the jury found Nelson Valdes guilty on all charged counts, including conspiracy to defraud the U.S. government, to submit false claims to Medicare, and to receive kickbacks; conspiracy to commit healthcare fraud; and three counts of receiving kickbacks in exchange for referring patients to co-conspirator pharmacies.

Valdes owned Florida Pharmacy and Discount and F & M Medical Rentals (Miami) from March of 2000 to the present. In September of 2001, Valdes conspired with the owners of Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for “compounded” aerosols. Compounding refers to the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.

After Unimed Pharmacy was shut down in 2003 by the FBI, Valdes obtained a pharmacy license through the assistance of Benjamin Metsch, an attorney convicted of Medicare fraud in 2006, and continued to compound medication for his paid patients. From 2001 to 2003, Unimed collected $7 million for aerosols, and from 2004 to 2007, Valdes’ pharmacy collected in excess of $3 million for aerosols and other durable medical equipment.

A Medicare beneficiary testified at trial that Valdes paid him $150 per month to use his Medicare card, and in return, Valdes received half of all of Unimed’s receipts from Medicare, and collected more than $40,000 for items that his own company never provided the patient. Evidence at trial established that Valdes continued to bill Medicare for many of his patients, even after his arraignment in this case.

“Focusing our energy and efforts on combating the most prevalent Medicare fraud schemes will help protect patients from unnecessary, non-FDA prescribed medication and help protect the financial viability of the health care program designed to help the retired and disabled,” said Assistant Attorney General Fisher. “The Criminal Division’s Fraud Section is providing leadership through the Medicare Fraud Strike Force and its work with U.S. Attorney’s Offices to take steps to assure we are preparing for the future in Medicare fraud enforcement.”

“The U.S. Attorney’s Office in the Southern District of Florida is working hand-in-hand with the Fraud Section to utilize the Medicare Fraud Strike Force to assure that those who steal from Medicare are prosecuted and appropriately punished,” said U.S. Attorney Acosta of the Southern District of Florida. “We will seek tough sentences for those who jeopardize the financial integrity of the Medicare program, particularly where their fraud endangers the lives of the elderly and disabled.”

Valdes faces a maximum sentence of 30 years in prison. He is scheduled to be sentenced on Sept. 26, 2007.