South Florida continues to distinguish itself as a hotbed of Medicare fraud. A husband and wife team pleaded guilty Friday in U.S. District Court in Miami for participating in a $13.7 million HIV infusion Medicare fraud scheme, according to the Departments of Justice and Health and Human Services.
Modesto de la Vega and his wife Victoria pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims to Medicare, and to pay healthcare kickbacks; one count of conspiracy to commit healthcare fraud; and three counts of submitting false claims. Each faces a maximum penalty of five years in prison for the conspiracy to defraud the U.S. and each false claims count, and 10 years in prison for the healthcare fraud conspiracy count. Sentencing is scheduled for Nov. 5.
The husband was the owner and operator of T&R Rehabilitation Professional Corp., a Miami clinic that provided expensive injection and infusion treatments to patients with HIV. His wife served as office assistant. Modesto de la Vega admitted during his hearing that he agreed with co-defendants and others to enlist patient recruiters and patients into a scheme to defraud Medicare. Both husband and wife admitted that they knew the patients did not need and/or did not receive the purported services, and that they would need to pay kickbacks and bribes to the patients so T&R could bill Medicare for the HIV infusion services that were not medically necessary and/or were not provided.
From Jan. 2003 to July 2005, the de la Vegas and their co-defendants were behind $13.7 million in fake claims submitted to Medicare, which paid about $4.1 million of the claims.
For a separate HIV infusion clinic Medicare fraud scheme, three other Miami-area residents were sentenced to prison.
To learn more:
- read the press release from the Department of Justice
- read the article in the South Florida Business Journal
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