Eight Miami-Area Residents Charged in $22 Million Medicare Fraud Scheme Involving...

Eight Miami-Area Residents Charged in $22 Million Medicare Fraud Scheme
Involving Home Health Care Agencies

Medicare Fraud Strike Force Charges Individuals, Freezes Assets

WASHINGTON, June 26 /PRNewswire-USNewswire/ -- Eight Miami-Dade County, Fla.,
residents have been indicted in connection with an alleged $22 million
Medicare fraud scheme operated out of Miami businesses purporting to
specialize in home health care services, announced Assistant Attorney General
Lanny A. Breuer of the Criminal Division, Acting U.S. Attorney Jeffrey H.
Sloman of the Southern District of Florida, and Daniel R. Levinson, Inspector
General of the Department of Health & Human Services (HHS). A temporary
restraining order freezing assets of the indicted defendants and their
companies was also filed.

Gladys Zambrana, Javier Zambrana, Enrique Perez, Alejandro Hernandez Quiros
aka Alex Hernandez, Vanessa Estrada, Vicenta Tellechea, Modesto Hidalgo and
Carlos Castaneda were charged in an indictment unsealed today in Miami with
conspiracy to commit health care fraud. Gladys Zambrana was also charged with
four counts of health care fraud. Gladys Zambrana and Hernandez Quiros were
charged with three counts each of paying health care kickbacks, while Perez,
Hidalgo and Tellechea were charged with one count each of paying health care
kickbacks. Gladys Zambrana, Perez, Alejandro Quiros, Tellechea and Castaneda
were also charged with conspiracy to launder health care fraud proceeds.

According to the indictment, Gladys Zambrana, Perez and Hernandez Quiros
operated ABC Home Health Care Inc. (ABC), listing Javier Zambrana as the
owner; and Gladys Zambrana and Castaneda operated Florida Home Health Care
Providers Inc. (Florida Home Health), listing Tellechea as the owner. Both
ABC and Florida Home Health purported to be home health agencies that catered
to Medicare beneficiaries. The indictment alleges that at both agencies,
beneficiaries were recruited and paid kickbacks and bribes to arrange for
their Medicare beneficiary numbers to be used by their co-conspirators to file
claims with Medicare for purported home health care services. The indictment
alleges that the services were not provided and were not medically necessary.

The indictment alleges that in addition to exerting ownership and control of
the home health agencies, Hernandez Quiros and Castaneda acted as Medicare
beneficiary recruiters for ABC and Florida Home Health, respectively; and
Hidalgo, a medical assistant, falsified medical tests and records to make it
appear that the services were needed. The indictment alleges that ABC billed
more than $17 million to the Medicare program for services provided from
January 2006 through December 2008 that were medically unnecessary and were
not actually provided. During that time frame, Medicare paid more than $11
million on those fraudulent claims submitted by ABC. The indictment also
alleges that from October 2007 through March 2009, Florida Home Health billed
more than $5 million to the Medicare program for services that were medically
unnecessary and not actually provided. During that time frame, Medicare paid
more than $4 million on those fraudulent claims submitted by Florida Home
Health.

The charge of conspiracy to commit health care fraud carries a maximum prison
sentence of 10 years. Each charged count of health care fraud carries a
maximum prison sentence of 10 years and each count of paying health care
kickbacks carries a maximum prison sentence of five years. Conspiracy to
launder health care fraud proceeds carries a maximum prison sentence of 10
years per count.

An indictment is merely a charge and defendants are presumed innocent until
proven guilty.

In conjunction with the criminal case, on June 24, 2009, the U.S. Attorney's
Office filed a civil complaint for injunctive relief under the fraud
injunction statute and obtained a temporary restraining order freezing the
assets of ABC, Florida Home Health, Gladys Zambrana, Javier Zambrana, Perez,
Hernandez Quiros, Castaneda and Tellechea. In addition, that temporary
restraining order also freezes certain financial assets of four other
companies the defendants owned or controlled and allegedly used to launder
money fraudulently obtained from Medicare. The temporary restraining order is
intended to preserve the remaining proceeds of the fraud for recovery by the
United States as part of the criminal case and any related civil proceedings.

"This indictment is a powerful example of the ongoing impact of the Medicare
Fraud Strike Force," said Assistant Attorney General Lanny A. Breuer. "Through
real-time data analysis, the Strike Force is at the forefront of stopping
health care fraudsters in their tracks."

"Health care fraud schemes in South Florida range from simple billing schemes
and fly-by-night durable medical equipment providers, to more sophisticated
frauds, including infusion fraud, fraud on the Medicare Advantage Program, and
now fraud in the delivery of home health services," said Acting U.S. Attorney
Jeffrey H. Sloman. "Today's coordinated criminal and civil action delivers an
effective one-two punch to health care fraudsters: they were not only caught
and criminally charged, but they are also being stripped of their illegal
proceeds."

"Today's arrests demonstrate our vigilance in combating home health fraud by
bringing to bear enforcement resources from across government," said Daniel R.
Levinson, Inspector General of the Department of Health & Human Services.
"These kickback schemes involving conspiracies between suppliers and
beneficiaries divert millions of dollars away from the Medicare beneficiaries
who truly need these critical services."

The criminal case is being prosecuted by Trial Attorney N. Nathan Dimock and
Deputy Chief Kirk Ogrosky of the Criminal Division's Fraud Section. The civil
case is being handled by Assistant U.S. Attorney Ted L. Radway of the U.S.
Attorney's Office for the Southern District of Florida. The case was
investigated by the FBI and the HHS Office of Inspector General.

The case was brought as part of the Medicare Fraud Strike Force, supervised by
the Criminal Division's Fraud Section and Acting U.S. Attorney Sloman of the
Southern District of Florida. Since strike force operations began in March
2007, 115 cases including 257 defendants have been indicted. Collectively,
these defendants are alleged to have fraudulently billed the Medicare program
for more than $600 million.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of
federal, state and local investigators designed to combat Medicare fraud
through the use of Medicare data analysis techniques and an increased focus on
community policing. In May 2009, the Department of Justice and HHS announced
the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint
effort to prevent fraud and enforce current anti-fraud laws around the
country. As part of the HEAT initiative, Medicare Fraud Strike Force
operations were expanded from South Florida and Los Angeles to Detroit and
Houston. To learn more about the HEAT initiative, go to:
www.hhs.gov/stopmedicarefraud.

SOURCE U.S. Department of Justice

U.S. Department of Justice, +1-202-514-2007, TDD: +1-202-514-1888