Miami Herald - September 2, 2008
Jay Weaver, jweaver@MiamiHerald.com

The group -- a physician, a clinic administrator and a money launderer -- admitted in separate plea deals last week that they aided an elaborate conspiracy to bill $110 million in false Medicare claims. Authorities say the ringleaders are three brothers -- Carlos, Luis and Jose Benitez -- who are suspected of operating about a dozen HIV infusion treatment clinics that collected $84 million in Medicare payments between 2001 and 2004. They fled to Cuba before their fraud indictment was unsealed in June, according to the FBI.

But others involved in their alleged Medicare scam, which authorities said included a vast network of straw owners, professional patients and kickback payments, are cutting plea deals and cooperating with prosecutors in bids to limit their prison time.

They're providing inside information about the Benitez brothers, who immigrated to this country in 1995 and became U.S. citizens five years later. Prosecutors say the brothers funneled millions of Medicare tax dollars through sham companies to finance their purchases of hotels, homes, cars, boats, horses, a helicopter and even a water park, all in the Dominican Republic. FBI agents have teamed up with Dominican police to seize their assets under a federal court order issued in Miami.

'MASTERMINDS'

Justice Department officials said they're attacking the longtime problem of healthcare corruption at all levels in South Florida.

"The department continues to focus on the masterminds of these frauds and the people who help them carry out the schemes, including doctors, nurses, clinic owners, employees and patients," said Kirk Ogrosky, deputy chief of the Justice Department's fraud section, who is supervising dozens of cases at the federal Medicare Fraud Strike Force in South Florida. The three defendants convicted last week played distinct roles in the brothers' alleged Medicare racket, authorities said.

WHAT THEY DID

* Miami-Dade physician Ronald E. Harris, 57, who is already in prison on a separate prescription-drug conviction, pleaded guilty to conspiring to defraud Medicare, filing false claims and paying kickbacks.

Harris admitted he schemed with Enrique Gonzalez -- now a fugitive believed to be in Cuba -- to bill Medicare for $26.2 million in bogus claims for obsolete HIV infusion therapy. They operated two clinics, Physicians Med-Care in Miami and Physicians Health in Hallandale Beach, which investigators say were controlled by the Benitez brothers. The businesses generated about $17.5 million in Medicare payments between 2002 and 2004.

'Harris' primary job at the [clinics] was to see patients, sign medical records and approve expensive and medically unnecessary HIV-infusion treatments," according to his factual statement filed with his plea agreement.

Among Harris' patients: Alexander McCray, 40, with a record of drug-possession arrests. The Opa-locka man has sold his Medicare number to these and other Benitez brothers' HIV-infusion clinics in exchange for kickbacks, according to federal authorities. McCray, who is HIV-positive and eligible for Medicare, told The Miami Herald that he collected tens of thousands of dollars from the clinics -- money he has used to pay for his crack-cocaine habit.

Since 2001, dozens of HIV clinics across Miami-Dade have billed more than $1.1 million in bogus bills to the taxpayer-funded program using McCray's Medicare number, according to claims records. McCray has not been charged as a "professional" Medicare patient.

The scams are especially outrageous because HIV infusion therapy, which entails intravenous drips of medication to boost a patient's immune system, has been replaced almost everywhere but South Florida by more effective antiretroviral drugs taken orally. Yet Medicare has continued to allow the outdated HIV infusion services and to pay hundreds of millions of dollars yearly for the treatments because the agency still considers them "reasonable and necessary."

PHONY CLAIMS

* Mariela Rodriguez, 40, of Miami, pleaded guilty to conspiring to defraud Medicare and lying to a federal grand jury.

In 2003, Rodriguez and a convicted co-conspirator, Aisa Perera, opened an HIV clinic for the Benitez brothers called Saint Jude Rehab Center in Miami.

According to her plea agreement, the clinic submitted about $11.3 million in phony claims to Medicare for HIV-infusion treatments that were neither medically necessary nor administered to patients.

For their part, the patients received $100 to $150 in cash per visit.

'FALSIFIED'

Medicare, in turn, paid $8.2 million of the clinic's fraudulent claims.

"Rodriguez knew that bills being submitted on behalf of Saint Jude to the Medicare program were falsified to justify the expensive HIV infusion treatments," according to the factual statement filed with her plea deal.

Rodriguez also admitted to lying to the federal grand jury in July 2004.

Asked if Saint Jude's patients were recruited off the street and paid kickbacks, she said: "I have no knowledge of that."

Authorities said McCray was among the clinic's recruited patients.

Another footnote in the Saint Jude case: Co-defendant Carmen Gonzalez, 34, a nursing assistant at the clinic, is suspected of fleeing with her father, Enrique Gonzalez, 63, to Cuba in June.

* In the third case, Juan Carlos Castaneda, 47, of Miami, pleaded guilty to a conspiracy to launder $1.8 million in Medicare payments from a local HIV clinic controlled by the Benitezes.

In his plea agreement, Castaneda admitted that in 2003 he drew checks on a bank account for G&S Medical Center and made them payable to various shell companies controlled by himself and the brothers.

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