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Miami Clinic "Consultant" Convicted in $6 M Medicare Fraud Plot

by Brendon Nafziger, DOTmed News Associate Editor | May 07, 2010
Cracking down on
Medicare fraud
As part of the government's ongoing crackdown on Medicare fraud, a self-styled "consultant" for a medical clinic in Miami was convicted on Tuesday for his role in helping to fraudulently bill Medicare nearly $6 million, in part by pretending his elderly aunt was HIV positive, the U.S. Department of Justice said.

David Marrero, 49, was convicted of health care fraud, conspiracy to commit money laundering and money laundering, according to the DOJ. He faces the possibility of years in prison and hundreds of thousands of dollars in fines.

According to the trial, in 2004 Marrero, with his then wife Maria Valero, helped open the clinic Tendercare Medical Center Inc., listing himself as a "clinical consultant." Between 2005 and 2007, Tendercare submitted around $5.8 million in dishonest claims to Medicare on behalf of Medicare beneficiaries for pricey injection and infusion medications to treat HIV and AIDS-related blood disorders, the DOJ said.

According to evidence given at the trial, the Medicare beneficiaries did not suffer from the conditions they billed Medicare for, nor were they ever given these medications.

As a result of the false claims, Medicare paid the clinic around $2.7 million.

According to the DOJ, Marrero also helped in a scheme where the clinic submitted claims pretending that his aunt, 76, was HIV positive, billing Medicare nearly $10,000 for a supposed first round of treatment using about 100 units of medication, a medically impossible amount, according to the testimony of a Medicare representative at the trial, who said it was the equivalent of injecting her with one liter of medicine.

During the trial, a Medicare witness said as a result of the investigation, new features have been added to automated Medicare processing claims to detect ones that are "medically impossible," a DOJ spokeswoman told DOTmed News.

At the trial, an employee of the clinic testified that Marrero taught workers how to create phony lab tests to trick the CMS. Evidence at the trial also showed the clinic paid kickbacks to beneficiaries to get them to join in on the scheme, according to the DOJ.

Marrero faces up to 10 years in prison for each count he was convicted of, as well as $250,000 in fines, or twice the gain or loss, whichever is greater. Sentencing is scheduled for July 30, 2010.

Last month, Marrero's wife Maria Valero, 48, the owner of the clinic, pleaded guilty to conspiracy to commit health care fraud, along with co-conspirators Lawrence Humes and Keith Humes, the DOJ said. Sentencing is scheduled for the end of July.

The case was brought in part by the Medicare Strike Force. Since its formation in March 2007, the Strike Force has obtained indictments of nearly 560 people who have collectively tried to bilk Medicare out of more than $1.2 billion, according to the DOJ.

One of the main cities under their scrutiny is Miami, considered the epicenter of Medicare fraud. In the last month alone, alleged Medicare fraudsters have been charged with nearly $100 million in crooked schemes, according to the DOJ and U.S. Department of Health and Human Services website Stop Medicare Fraud.