Raymond and Emelitza Arias, owners and operators of two clinics purportedly specializing in treatment of HIV and other conditions, have pleaded guilty to conspiracy to commit healthcare fraud, according to the Justice Department. The Medicare fraud scheme involved false claims for infusion therapy services through the two clinics: Carefirst Occupational & Rehabilitation Center Inc. and Elite Wellness LLC.
Purported HIV Treatment Clinics Fraudulently Billed Medicare for Infusion Therapy
Mr. Arias orchestrated the schemes at both clinics. He paid physicians to refer their Medicare patients to Elite Wellness, and he purchased identification for Medicare beneficiaries in order to submit false claims to the Medicare program for infusion therapy services that were not actually provided to the Medicare beneficiaries. Over a one year period, the Medicare fraud scheme at Elite Wellness caused the submission of about $12.5 million in false claims. Medicare actually paid about $5.4 million of those fraudulent claims. After installing a nominal new owner for Elite Wellness, Mr. Arias and his co-conspirators submitted $10 million in Medicare claims through Elite Wellness in just three months.
Ms. Arias participated with her husband in a Medicare fraud scheme that was run through Carefirst Occupational & Rehabilitation Center. In less than a year, they submitted over $900,000 in Medicare claims for infusion therapy services that were purportedly rendered by Carefirst. Medicare actually paid about $530,000 of those fraudulent claims. In order to make Carefirst look like a legitimate clinic, Ms. Arias injected vitamins into the Medicare beneficiaries who visited Carefirst.
When they are sentenced in February 2013, Mr. and Ms. Arias face as much as 10 years in prison. They could also be ordered to pay a $250,000 fine.
Whistleblowers Help Stop Medicare Fraud
Medicare fraud is a very serious problem. Because whistleblowers can be part of the solution, the qui tam provisions of the False Claims Act let whistleblowers file suit to address Medicare fraud and to share in any money recovered.
The attorneys at Waters & Kraus have extensive experience working with Medicare fraud whistleblowers. Contact us or call our whistleblower attorneys at 800.226.9880 to learn more about our practice and how we can assist.