A Miami physician, Rene De Los Rios, was convicted for his role in a $23 million HIV injection and infusion Medicare fraud scheme. He was convicted on five felony counts by a federal jury, according to a Department of Justice (DOJ) and Health and Human Services (HHS) announcement on April 14, 2011.
De Los Rios will be sentenced on June 27, 2011. He faces a maximum prison term of 10 years and a $250,000 fine for the single count of conspiracy to commit health care fraud; he faces maximum prison time of five years on each of the four counts of submission of false claims to Medicare.
Trial evidence showed that Metro Med of Hialeah Corp owner Damaris Oliva started an HIV infusion clinic to provide injection and infusion therapies to Medicare beneficiaries suffering from HIV.
The truth, however, was that the therapies were neither medically necessary nor provided. Metro Med got the beneficiaries to provide their personal and Medicare information in exchange for cash kickbacks.
Dr. De Los Rios was hired by Oliva to put a proper medical face on the scam. The doctor ordered unnecessary tests, signed medical diagnosis and analysis forms and authorized treatments at the clinic which Oliva then billed to Medicare.
De Los Rios would often sign patient charts indicating the need for injection and infusion treatments although he had never seen the patients. Evidence also showed he gave the same rare blood disorder diagnosis to almost patients. Although none of them had the disorder, it qualified for the maximum reimbursement from Medicare.
In addition to the injection and infusion treatments, De Los Rios also prescribed Winrho, Procrit and Neupogen, very expensive medications, solely to make the claims Medicare reimbursable. Oliva paid De Los Rios $3,000 per week to participate in the HIV infusion scam.
Metro Med submitted approximately $23 million in claims from approximately April 2003 through October 2005 for the injection and infusion treatments for Medicare beneficiaries. None were medically necessary and none were provided.
Medicare paid approximately $11.7 million in claims for these treatments. Oliva and three others have each pleaded guilty to conspiracy to commit health care fraud in connection with the scheme but have not yet been sentenced.
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