Miami Herald - March 17, 2009
Jay Weaver

The 12-person jury found Dr. David Rothman, Dr. Keith Russell, Eda Marietta Milanes and Jorge Luis Pacheco guilty of conspiring to commit fraud and other charges for filing $5.3 million in false HIV therapy claims with the nation's healthcare program for the elderly and disabled.

The taxpayer-funded insurance program paid their two clinics about $2.5 million for services that were never provided to patients between 2004 and 2006.

On Saturday, Pacheco, a former physician in Cuba, attempted to flee the United States just before the jury was to begin deliberations on Monday. He was arrested in the Homestead area with $12,600 in cash and a false Florida driver's license in the name of "Jose Luis Falcon," federal authorities said.

Before his arrest, Pacheco cut off his ankle monitor in violation of the terms of his bond, and documents seized from him contained multiple contacts in the Dominican Republic, authorities said.

Pacheco, 50, told police that he was "going fishing."

The former Cuban physician had played a key role as a medical assistant in the Medicare scheme by determining which HIV infusion drugs would be falsely billed to the federal agency.

Medicare wound up paying the racket's two Miami-Dade clinics for obsolete HIV infusion treatments that were either medically unnecessary or never provided to the patients -- another sign of the government agency's chronically lax oversight of fraudulent clinics in Miami-Dade County.

"I now know it was something despicable," testified the owner of the two clinics, Juan A. Marrero, who had pleaded guilty along with three other defendants before trial.

Marrero testified that Rothman was paid $200,000 and Russell $40,000 for writing prescriptions for the outdated intravenous therapy. Marrero said he paid $200 kickbacks to patients for each visit to use their Medicare numbers to submit the bogus bills.

He also said the medical assistants manipulated blood platelet levels in patient records to justify their treatments to Medicare, and that he obtained fake invoices from a drug wholesaler to show that his clinics had provided the infusion drugs to patients. He said the clinics even emptied the drug-infusion bottles to make it look like they were actually used to treat patients.

"We wanted to make it appear we were providing the services," Marrero testified.

The defendants are part of a growing list of dozens of South Florida doctors and assistants convicted for billing Medicare hundreds of millions of dollars in fraudulent claims for outdated HIV infusion therapy administered intravenously.

The obsolete therapy was replaced about 15 years ago by more effective antiretroviral drugs taken orally, experts say, yet Medicare continues to pay for the infusion therapy because the agency still considers it "medically reasonable and necessary."

Dr. Michael Wohlfeiler, a Miami Beach physician whose practice treats some 2,500 HIV/AIDS patients, testified that antiretroviral drugs -- dubbed the "cocktail" -- have turned a rapidly terminal illness into a chronically managed disease. He questioned why Medicare would continue to foot the bill for such obsolete infusion treatment for HIV patients.

"Just the fact that Medicare pays for it doesn't mean it should be the treatment," Wohlfeiler testified. "We have regimens that are as simple as one pill a day."

He also said the HIV infusion drugs, if actually administered, would harm patients already taking the cocktail orally.

At trial, Justice Department prosecutors Jay Darden and Kirk Ogrosky unveiled evidence that the two Miami-Dade physicians, Rothman and Russell, had been involved in other HIV clinics that falsely billed Medicare. They said Rothman, 66, wrote prescriptions for about $60 million in phony HIV treatments from 2004 to 2005, and that Russell, 65, also wrote prescriptions for millions of dollars at other clinics.

Although the federal agency that operates Medicare says it has stopped about $2 billion in "improper payments" for HIV infusion services in South Florida over the past five years, the agency and its Florida claims contractor, First Coast Service Options, continue to pay out hundreds of millions of dollars a year.

"We feel there has absolutely been a decrease," Kimberly Brandt, Medicare's anti-fraud director, said in a recent interview. "Whether it's enough of a decrease, it's open to opinion."

Medicare officials say the agency won't stop HIV infusion therapy in South Florida because they still consider it necessary for some patients -- even though the Department of Health and Human Services' Office of the Inspector General issued a dire warning in 2007 about fraudulent billing activity -- especially in South Florida.

The inspector general's report noted that South Florida's HIV clinics submitted $2.2 billion in claims for HIV infusion therapy in 2005 -- 22 times the total filed by providers in the rest of the country combined.

In a letter responding to that report, Medicare officials stressed the agency is making progress in containing HIV claims abuse in the entire state of Florida. They noted that HIV infusion clinics in Florida billed Medicare $1.5 billion in 2004 and that the agency paid out $1 billion. By comparison, they said Florida clinics filed more than $3 billion in claims for HIV infusion services in 2005 and 2006, with Medicare paying out about $900 million in each of those years.

The FBI and other law enforcement officials say that trend continues to this day.
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