Miami physicians Carlos Contreras, MD, and Ramon Pichardo, MD, pled guilty last week to defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme.
Contreras, 60, pled guilty to conspiracy to commit healthcare fraud before U.S. District Judge Federico Moreno in Miami. In his plea, Contreras admitted that he owned a Miami clinic named CNC Medical Inc., which purported to specialize in the treatment of HIV-positive patients.
Contreras admitted that, from November 2002 through April 2004, he conspired with others to submit approximately $6.8 million in fraudulent Medicare bills, he signed documents containing false information about treatments purportedly given to HIV-positive patients and he approved medically unnecessary treatments at CNC.
Contreras also admitted that the clinic received approximately $4.2 million from the Medicare program as a result of his and his co-conspirators' conduct.
According to Acting Assistant Attorney General Matthew Friedrich of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida, Contreras admitted that he entered into an agreement in approximately November 2002 with Carlos Benitez, Luis Benitez, Thomas McKenzie, Pichardo and others to operate CNC as a fraudulent HIV infusion clinic.
According to federal officials, Contreras admitted that the Benitez brothers would refer HIV-positive Medicare beneficiaries to the clinic, provide staff members to work at the clinic and transport patients to CNC in exchange for a substantial share of CNC's profits.
In addition, they said, Contreras was aware that the patients referred to CNC by the Benitezes were paid cash kickbacks in exchange for visiting the clinic and allowing their names to be used to bill the Medicare program. And, they said, he admitted that he agreed to approve expensive and medically unnecessary HIV infusion claims at the clinic, and to falsify medical records.
Pichardo, 58, also pled guilty to one count of conspiracy to commit healthcare fraud. Pichardo admitted in his plea that he worked as a physician at CNC and conspired with the Benitezes, McKenzie, Contreras and others to assist in operating CNC as a fraudulent HIV infusion clinic.
Officials said Pichardo further acknowledged that he and Contreras ordered numerous unnecessary and expensive HIV infusion treatments for the purpose of defrauding Medicare rather than providing legitimate healthcare services.
In a related case, Carlos and Luis Benitez, their brother Jose Benitez and McKenzie were indicted on June 11, 2008, for their role in a $110 million HIV infusion and money-laundering scheme. The indictment alleges that the Benitez brothers were the masterminds of a massive HIV infusion fraud operation throughout South Florida involving at least 11 clinics and that they laundered the proceeds of their crimes.
According to the indictment, Carlos and Luis Benitez were the true owners of CNC. All three Benitez brothers remain fugitives, while McKenzie is being detained pending an Oct. 14, 2008, trial.
Federal prosecutors have indicted 82 cases with 142 defendants in South Florida since investigations opened during the period of strike force operations between March and October 2007. Collectively, these defendants fraudulently billed the Medicare program for more than $492 million.