Monday, March 31, 2014

Mario and Gladys Fuertes Arrested for Operating Clinic to Defraud Medicare #HealthCareFraud

United States Attorney A. Lee Bentley, III announces the unsealing of an indictment charging Miami residents Gladys Fuertes (40) and her husband Mario Fuertes (38) with conspiracy, health care fraud, aggravated identity theft, and obstructing a healthcare investigation. The Fuerteses were arrested on in Miami. If convicted, each faces a maximum penalty of 10 years in federal prison on each of the conspiracy and health care fraud counts and five years on each of the obstruction counts, as well as mandatory sentences of two years in prison for each of the aggravated identity theft counts. The indictment also notifies the couple that the United States is seeking a money judgment in the amount of $266,423.20, which is traceable to the proceeds of the alleged criminal conduct.

According to the indictment, Gladys and Mario Fuertes established and operated a sham clinic in Coral Gables, Florida, for the purpose of committing health care fraud. The clinic was called Gables Medical and Therapy Center. The Fuerteses allegedly employed unlicensed medical professionals and misused the Medicare billing numbers of other medical professionals, without their knowledge, in order to claim that they rendered medical treatment to Gables patients. Gladys and Mario Fuertes also paid a co-conspirator to recruit Medicare beneficiaries for Gables and to drive patients to the clinic for basic and sham medical services.

Once recruited, Gladys and Mario Fuertes urged the Gables patients to enroll in Universal’s Medicare Part C and Part D plans. They believed Universal paid a relatively high percentage of its claims. Gladys and Mario Fuertes fraudulently billed Universal and caused Universal’s Medicare Part C plan to be billed for Gables patients’ supposed treatments. The treatments included expensive HIV-related treatments that patients never actually received. Gladys and Mario Fuertes also billed Universal and caused Universal to be billed for services that required a physician’s presence when no licensed physician was present or rendered the service.

The defendants and their co-conspirators paid the Medicare beneficiaries, who were recruited to come to Gables for their Medicare identification numbers, to allow Gables to bill Universal for services that were never rendered. In addition, Gladys and Mario Fuertes facilitated the provision of fraudulent prescriptions for controlled substances, including oxycodone, to Gables patients. In some cases, the signatures on the prescriptions were forged. The patients who received these oxycodone prescriptions were assisted in filling them by a co-conspirator. The co-conspirator also purchased the pills from some of the patients and sold them on the street.

Once they learned of the federal health care fraud investigation into their actions, Gladys and Mario Fuertes instructed Gables patients to lie to law enforcement agents and otherwise obstruct a federal investigation into health care fraud at Gables. The Fuerteses also provided altered Medicare billing documentation to federal agents investigating their activities.

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