Clinic Owner Sentenced to 60 Months in Prison for Medicare Fraud Scheme

Yudel Cayro, owner and operator of Courtesy Medical Group Inc., a medical clinic in Miami, was sentenced to 60 months in prison for his role in a wide-ranging Medicare fraud scheme involving Miami-area home health agencies, the Departments of Justice and Health and Human Services (HHS) announced.

U.S. District Judge Adalberto Jordan also ordered Cayro to serve two years of supervised release following his prison term and ordered him to pay $9.8 million in restitution jointly and severally with his co-defendants and co-conspirators in a related case. The restitution is to be paid to the victim in this case, the Centers for Medicare and Medicaid Services (CMS).

According to court documents, Cayro admitted that Courtesy operated in part to provide unnecessary prescriptions, plans of care and medical certifications, among other things, to Miami-area home health agencies in return for kickbacks and bribes. Courtesy provided the fraudulent medical documents so that the home health agencies could bill the Medicare program for expensive home health services and therapy purportedly for insulin dependant diabetic Medicare beneficiaries. In fact, the beneficiaries did not need and in some cases did not receive the services.

According to court documents, approximately 344 prescriptions for these unnecessary services were issued through Courtesy and signed by Cayro's co-defendant, Dr. Fred Dweck. As a result, Medicare was fraudulently billed approximately $16.6 million for home health services. Medicare paid almost $10 million of the fraudulent claims. Another owner and operator of Courtesy, co-defendant Arturo Fonseca, was sentenced in November 2010, by Jordan to 60 months in prison and two years of supervised release.

Three of Cayro's co-defendants, Miami-area nurses Armando Sanchez, Marlenys Fernandez and Silvio Ruiz were sentenced last week to prison for their roles in the scheme. Sanchez and Fernandez were each sentenced to 30 months in prison. Ruiz was sentenced to four months in prison. Jordan also ordered Fernandez to pay $331,622, Sanchez to pay $602,585, and Ruiz to pay $79,230 in restitution to CMS, jointly and severally with their co-defendants and co-conspirators in a related case.

On Dec. 7, 2010, another co-defendant, registered nurse Sheillah Rotta, was sentenced by Jordan to two months in prison, followed by two years of supervised release, for her participation in the scheme. Rotta was also ordered to pay $74,164 in restitution to CMS, jointly and severally with her co-defendants and co-conspirators in a related case.

According to court documents, the nurses were engaged in the fraudulent scheme at ABC Home Health and Florida Home Health Care Providers Inc., two Miami home health agencies that were engaged in billing the Medicare program for unnecessary home health services for Medicare beneficiaries. Specifically, the nurses admitted to falsifying patient files to make it appear that these Medicare beneficiaries qualified for two to three times daily skilled nursing visits to purportedly administer diabetic insulin injections. In fact, these Medicare beneficiaries did not need nor qualify for these services.

According to court documents, Sanchez admitted that as a result of his actions, more than $900,000 was falsely billed to the Medicare program; Fernandez admitted to causing approximately $500,000 in fraudulent billings to Medicare; Rotta admitted to causing more than $100,000 in fraudulent billing; and Ruiz admitted to causing approximately $115,000 in fraudulent billing.

Additional co-defendants await sentencing in January 2011, including Dr. Fred Dweck, whose sentencing was continued to Jan. 28, 2011.

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