Miami Herald - August 20, 2007
John Dorschner, jdorschner@MiamiHerald.com

In a second infusion case, prosecutors announced charges against a physician and a physician's assistant who worked at the federal detention center in downtown Miami across the street from the U.S. Attorney's Office. The two were part of a group that ran a Hialeah clinic that improperly collected $2 million from Medicare.

In the crackdown, all South Florida seniors should soon see the biggest change: They will start receiving Medicare explanation of benefits forms monthly, rather than quarterly, because those engaged in healthcare fraud tend to open and close operations quickly to avoid detection.

Officials asked all Medicare recipients to check these forms carefully and report any fraudulent claims to 1-800-HHS-TIPS.

The move is part of a two-year demonstration project in South Florida to curtail infusion fraud. Another measure will require all clinics offering infusion treatments to re-apply for licenses in the next 30 days or risk losing their billing privileges. The clinics will be subject to on-site visits.

In a conference call with journalists, federal officials used the two cases to show how South Florida was "so out of whack," in the words of one fraud expert, with the rest of the country in how much it spends on expensive infusion treatments, which are intended for HIV-AIDS patients.

One example, from U.S. Attorney R. Alexander Acosta: In 2004, the cost of infusion treatments per AIDS patient in Florida was $16,000, while in New York it was $2,000. Acosta said the South Florida average was much higher than the rest of Florida's.

In the billing company case, Rita Campos Ramirez, owner of R and I Medical Billing at 8300 SW 8th St., was charged with conspiracy to commit healthcare fraud and submission of false Medicare claims for sending in $170 million in claims from 75 Miami-based clinics from October 2002 to April 2006.

Campos received 5 percent of all paid claims -- or about $5 million, according to the Medicare Fraud Strike Force, which is handling the case. She has pleaded guilty to both counts. She agreed to help prosecutors and to forfeit $1.5 million that she has remaining. However, she remains liable for the full $105 million lost.

In the other case, a group established United Life, a clinic in Hialeah. Among those participating were Rupert Francis, 66, of Davie, a doctor serving inmates at the Federal Detention Center in Miami, and Luis Garcia Higgins, 46, of Sunny Isles. Both resigned in April 2006.

They were charged with conspiracy to commit healthcare fraud. Francis has pleaded guilty, prosecutors stated in a press release.

Also charged in the United Life case were Lester Miranda, 31, of Miami Beach, owner of the clinic; Ariel Estevez, 32, of Hialeah, who oversaw day-to-day operations; and Karina Estevez, 32, of Hialeah, Ariel's wife, who helped manage the business. The group is accused of filing $7 million in fraudulent claims with Medicare.

During the teleconference, Medicare officials said that computer edits had stopped $1.8 billion in fraudulent infusion claims in the past two years, but that hundreds of millions in claims had been paid out.

This fiscal year, the U.S. Attorney's Office has prosecuted cases involving more than $470 million in all sorts of Medicare fraud claims, but "prevention is really the most important object" in stopping fraud before it is committed, Acosta said.

When The Miami Herald first reported on the infusion scam in 2005, clinics were recruiting drivers to bribe homeless persons who were HIV positive to go for treatments of infusion drugs that might cost $6,000 each, if the drugs were real. The homeless, many of them in downtown Fort Lauderdale, received $100 to $300 per visit to the clinic.

On Monday, Acosta said that in some fraud cases, clinics continue to bring the HIV/AIDS patients to the clinics, but in others, the clinics simply steal the identities/Medicare numbers of patients and the patients never come to the clinics.

The Campos case was prosecuted by Kirk Ogrosky and Hank Bond of the Strike Force. The United Life case is being prosecuted by Christopher J. Clark.

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