Tampa Medicare Fraud Scheme Involving Illegal Oxycodone Leads Back to Miami Area By Tod Aronovitz | 04/10/14 | 0 Comment

Four people, including Brian Francis Kelly of Broward County, have been accused of conspiracy to defraud the Medicare system by allegedly filing false claims for prescription drugs and medical care through Universal Health Care Group, a St. Petersburg Medicare insurer which is no longer in business.

In addition to 53-year old Kelly, the U.S. Attorney’s Office in Tampa unsealed indictments against Gladys Fuertes, 40, Mario Fuertes, 38, and Cathleen Ortega, 55. An investigation into the Tampa Medicare fraud by the Tampa Bay office of the Medicare Fraud Strike Force found that the four were allegedly involved in a scheme that used HIV patients and a Coral Gables clinic to defraud the government, an article in the Miami Herald said.

According to Kelly’s signed plea agreement, he recruited patients for Gables Medical and Therapy Center, which was owned by the Fuertes. Then using those patients’ identities, the clinic fraudulently claimed reimbursements for medical treatments not provided. In return, the recruited patients received kickbacks and oxycodone prescriptions, some of which were forged by the Fuerteses.

The plea document also reveals that some of the patients sold their filled prescriptions to Kelly for cash, who consequently peddled the oxycodone to street-level users and other distributors in Florida and Pennsylvania for about $25-$50 per pill. The prescriptions, which were filled at a Fort Lauderdale pharmacy, submitted claims for reimbursement to Universal’s Medicare Part D plan, the federal program which helps subsidize the cost of prescription drugs.

In addition, the Gables clinic submitted claims for treatment in excess of $1 million, of which Universal paid $266,423, according to Kelly’s plea agreement. In one case alone, Universal was billed $91,342 for a Gables clinic patient who received no treatment, the document states. It’s unclear how much government money went toward the illegal oxycodone prescriptions.

In the current Tampa Medicare fraud case, Kelly admitted to conspiracy to commit health care fraud. He still has to make a court appearance to formalize his plea deal. The Miami Herald also says that Kelly was convicted on possession with intent to distribute methamphetamine in Broward in 2006. He is originally from Massachusetts.

As for the others, Ortega admits to making false statements to investigators, and the Fuerteses were arrested in Miami and charged with health care fraud, aggravated identity theft and obstructing a health care investigation.

Universal Health Care Group filed for bankruptcy last year in the midst of fraud and embezzlement allegations, but the government now calls the insurer “a victim of fraud” due to this latest development.

How to Report Tampa Medicare Fraud

Healthcare professionals who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.