Miami Herald - June 24, 2009
Jay Weaver, jweaver@MiamiHerald.com

The series of indictments, returned by a federal grand jury in eastern Michigan over the past two months, highlight HIV infusion and physical therapy scams that have been commonplace in Miami and were transported to Detroit, the latest Medicare fraud hot spot.

The seriousness of the problem in Detroit, where a strike force was recently established, prompted Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius and FBI Director Robert Mueller to conduct a news conference Wednesday at the Justice Department in Washington.

The Obama administration has made stopping Medicare fraud a top priority as it strives to prevent billions of dollars in losses -- one of several huge challenges to the president's agenda to expand healthcare coverage to all uninsured Americans.

"As demonstrated by today's charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising healthcare costs that all Americans must bear," Holder said at the mid-day press conference.

On the whole, the indictments allege phony prescriptions, cash kickbacks and stolen Medicare and physician ID numbers -- all signatures of scams that have been rampant in South Florida over the past five years. All the services were not provided or not medically necessary, but Medicare ended up footing much of the bill because of poor scrutiny of claims.

As authorities cracked down on the crisis in Miami, perpetrators began exporting their schemes to Detroit and other cities in attempts to exploit Medicare's notoriously lax oversight.

Overall, the grand jury in eastern Michigan returned two indictments alleging nearly $40 million in false Medicare claims for physical and occupational therapy that was never provided.

The grand jury also filed five indictments alleging more than $16 million in phony Medicare bills for unnecessary infusion services to treat HIV patients. Those services were never provided, but Medicare approves the claims because the agency still considers such therapy "reasonable and necessary." The treatment, which involves intravenous injections, has been rendered obsolete by more effective antiretroviral drugs taken orally, experts say.

About a dozen of the suspects named in the indictments unsealed Wednesday have ties to Miami-Dade. Among those in custody: Arturo Apolinar, 55, who was arrested in late May at Miami International Airport as he was traveling from Havana to Detroit, where he owned a clinic that billed Medicare for HIV infusion services.

Of the 53 defendants named in the indictments, about 35 have been arrested by FBI and other federal agents. More arrests are expected later through the week. They represent the first Medicare fraud prosecutions for the Justice Department's new strike force in Detroit.

All together, strikes forces in Miami, Los Angeles and Detroit have charged 249 defendants for Medicare fraud involving about $600 million in false claims for mostly HIV infusion services and medical equipment.

Since 2005, the U.S. attorney's office in Miami has prosecuted some 800 defendants who submitted $2 billion in phony bills to Medicare -- accounting for one-third of such cases nationwide. Among the latest busts: an eight-person, Miami-based ring that exported HIV scams to four other southern states, according to an indictment unsealed Tuesday.

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