Widespread Medicare Fraud Scheme Uncovered in Key Biscayne After Secretary’s Blunder By Tod Aronovitz | 07/23/14 | 0 Comment

It all started with a misdirected fanny pack. Now, two secretaries in a Key Biscayne doctor’s office have pleaded guilty to health care fraud, and there’s an ongoing criminal investigation against a pharmacy owner.

Last fall, kidney specialist Dr. Carmen Ortiz-Butcher asked one of her secretaries to mail a fanny pack to her brother, but instead he received a stack of prescriptions supposedly signed by the doctor, according to news story in the Miami Herald on July 11. Authorities were alerted and found an interrelated network of fraud that cost the government up to $7 million.

That helped to explain why in a ProPublica report—suggesting that lax oversight has propelled massive waste and fraud in Medicare’s Part D prescription drug program—Ortiz-Butcher’s prescriptions were found to have skyrocketed from $282,000 in 2010 to $4 million in 2011, and continued to rise to almost $5 million in 2012, the Herald article said.

Secretary number one—Maria De Armas Suero, who worked in Ortiz-Butcher’s Island Clinic from March 2011 to September 2013—was charged with 11 counts of conspiracy, fraud and aggravated identity theft in February by the U.S. Attorney’s Office for the Southern District of Florida. She subsequently pleaded guilty to two counts of conspiracy and identity theft.

In acknowledging her wrong-doing, Suero admitted to creating false prescriptions that represented the Medicare beneficiaries were seen by Ortiz-Butcher and that the prescriptions were medically necessary. She received $100 for each prescription she generated.

Secretary number two–Milagros Matias Ortiz—also admitted to creating false prescriptions while working at the clinic from March 2011 to August 2012. She was paid $50 per prescription, and has agreed to plead guilty to two counts of conspiracy to commit healthcare fraud and aggravated identity theft.

After writing the fake prescriptions, local pharmacies then filled them and billed Medicare. Sometimes they were never dispensed. As a result, losses to Medicare totaled at least $2.5 million, the article said.

Dr. Ortiz-Butcher was not involved in the scam and is pleased that the case is being resolved. Sentencing for Suero and Ortiz is scheduled for this month, but the story doesn’t end there.

In May, Luisa Isabel Vega, owner of AB Pharmacy in Miami, was charged with conspiracy and fraud relating to Medicare claims made by Ortiz-Butcher. Medicare overpaid AB Pharmacy $4.2 million from April 2011 to November 2013, the indictment said.

According to the affidavit of Daniel Crespi, a special agent with the Health and Human Services Inspector General’s office, several Medicare beneficiaries filled their prescriptions at AB Pharmacy, and received kickbacks for allowing AB Pharmacy to submit fraudulent claims to Medicare on their behalf for medications they most often did not receive.

In the affidavit, Crespi concluded that a doctor’s signature (ProPublica data shows it was Ortiz-Butcher, the Herald article said) was being forged after finding that only 17 of 181 prescriptions sent to AB Pharmacy for Medicare beneficiaries were actually patients of hers. Medicare data show that 7,613 prescriptions attributed to Ortiz-Butcher were filled at AB Pharmacy in 2012, more than any other doctor.

The second highest Medicare prescriber to AB Pharmacy was Miami physician Aurelio Ortiz, who showed a similar jump like Ortiz-Butcher’s from $2.1 million in 2010 to $8.7 million the next year. Although the doctor said he doesn’t remember whether all the prescriptions were his, he had been aware that some fake prescriptions had been written using his name, according to the Herald article. He has not been charged.

The U.S. Attorney’s office is investigating additional cases related to prescriptions attributed to Ortiz-Butcher. Criminal cases have also been brought against two other pharmacies that filled Ortiz-Butcher’s prescriptions, but those investigations began before the doctor uncovered the scam in her office.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees 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 up 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 your case.