Three Defendants Plead Guilty to Their Roles in $6.5 Million Medicare Fraud Scheme

Alfredo Rasco, 51, and Niurka Rasco, 49, both from Miami, Florida, and Iris Oswald, 54, from St. Simons Island, Georgia, pleaded guilty earlier this week before United States District Court Judge William T. Moore, Jr. to their roles in a scheme to defraud Medicare of $6.5 million. Seconds before the scheduled start of the government’s evidence in the trial, the defendants pled guilty.

United States Attorney Edward J. Tarver stated, "Health care fraud is one of our most urgent and widespread national challenges. Offenders who steal from Medicare will be caught, sentenced to long prison sentences and their ill-gotten gains will be forfeited. The United States Attorney’s Office is committed to strengthening the Medicare program through the vigorous prosecution of those who defraud the American people."

Evidence during the guilty pleas showed that from December of 2005 through March of 2008, Alfredo Rasco, Niurka Rasco, Iris Oswald, and others operated United Therapy, a phony medical clinic located in downtown Savannah. The defendants and others lured Medicare beneficiaries to United Therapy with free food, transportation, and gift cards. Many of the Medicare beneficiaries targeted by the scheme were afflicted with HIV or AIDS and lived in local homeless shelters and Section VIII housing. Once at United Therapy, the Defendants used the patients’ Medicare information to submit $6.5 million worth of phony bills to Medicare for infusion services that were not provided to those patients. Before law enforcement put a stop to this fraud, the defendants stole over $4 million from Medicare.

For his role in the scheme, Alfredo Rasco faces a maximum statutory penalty of up to 12 years in prison, fines up to $500,000, and three years of supervised release. Niurka Rasco faces a maximum statutory penalty of up to six months in prison, a fine up to $2,000, and one year of supervised release. The Rascos also forfeited proceeds of the scheme, including $1.3 million seized from their bank accounts and a 42' powerboat they named "Thank You, God." For her role in the scheme, Iris Oswald faces a maximum statutory penalty of five years in prison, a fine up to $250,000 and three years of supervised release. Ms. Oswald also agreed to forfeit a home she purchased on St. Simons Island with proceeds of the fraud scheme.

All three defendants remain on bond pending sentence, which will be held upon the completion of a pre-sentence investigation and report.

Mr. Tarver praised the hard work and dedication of Special Agents Tony Alig and Josh Hayes of the Federal Bureau of Investigation, along with Special Agent David Graupner of the Office of Inspector General for HHS, who led the investigation of this case. Tarver noted that the indictment against these defendants arose out of Operation Redex Infuscam, a major investigation led by the Federal Bureau of Investigation (FBI) and the Office of Health and Human Services (HHS) into fraudulent infusion billings to Medicare in and around the Southern District of Georgia. Tarver also recognized the extensive efforts provided by investigator Kim Reinken and auditor Karen Hartley of the United States Attorney’s Office for their contributions to a successful prosecution.

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Miami Man Sentenced to More Than a Decade in Federal Prison for Million-Dollar Medicaid Fraud

VARIAN V. SCOTT, 36, of Miami, Florida, was sentenced today by United States District Judge Charles A. Pannell, Jr. to federal prison on charges of health care fraud and conspiracy to commit health care fraud. The charges arose out of a scheme to present forged doctors’ prescriptions for high-dollar cancer and HIV medications to dozens of Atlanta-area pharmacies using the identities of Georgia Medicaid recipients, causing the cost of the medications to be billed to the Georgia Medicaid program, and resulting in an approximately $1.1 million loss to state and federal taxpayers.

Georgia Attorney General Thurbert Baker said, “The defendant and his cronies not only defrauded Georgia’s taxpayers, but they endangered the patients who were on the receiving end of these re-sold prescriptions. These medications must be handled and stored with extreme care to preserve their effectiveness, and street sellers aren't known for running hygienic operations. Prison is the appropriate place for Scott, and today's prison sentence sends a clear message that law enforcement will protect taxpayer resources and preserve the integrity of these critical treatment programs.”

FBI Atlanta Special Agent in Charge Gregory Jones said, “Mr. Scott will now sit in prison for many years hopefully thinking about the crimes he committed and their full impact on the people that could have used the help that was, instead, diverted to his bank account through greed. Medicaid fraud and healthcare fraud in general cannot and will not be tolerated and the FBI recognizes these crimes for what they are, acts of greed and indifference to others.”

Dr. Rhonda Medows, Commissioner of the Georgia Department of Community Health, which administers Georgia Medicaid, said, “This case is a perfect example of what government agencies can accomplish when they share information and partner on key initiatives. With an increasing number of people in need of health care, it is important that we continue to work with our partners to ensure that we safeguard taxpayer dollars.”

SCOTT was sentenced to 12 years in federal prison, to be followed by three years of supervised release. There is no parole in the federal justice system. SCOTT was also ordered to pay $1,142,720.67 in restitution to Georgia Medicaid. SCOTT was convicted of these charges on October 5, 2009, after a four-day jury trial.

According to Acting United States Attorney Sally Q. Yates, the charges, and other information presented in court: SCOTT directed and funded a health care fraud conspiracy between September 2005 and April 2006. SCOTT and his cousin, HEZRON D. COLLIE, 29, of Atlanta, Georgia, bought blank doctors’ prescription pads from insiders at Emory University’s Winship Cancer Institute and two other doctor’s offices, one in Atlanta and one in Florida. SCOTT and COLLIE then bought names, dates of birth, and Medicaid numbers of dozens of Georgia Medicaid recipients, and forged approximately 164 doctors’ prescriptions for Neupogen, a chemotherapy drug, and multiple medications used to treat HIV, using the patient Medicaid information. A one-month supply of Neupogen costs approximately $10,000.

SCOTT and COLLIE then presented the forged prescriptions along with the patient information to CVS, Publix, Walgreens, Kroger, and Eckerd pharmacies throughout the Atlanta area. SCOTT and COLLIE also recruited a pharmacist at one of the Publix pharmacies, and a pharmacy technician at one of the Kroger pharmacies, to help facilitate the scheme. The pharmacies billed approximately $1.1 million to Georgia Medicaid for the cost of the medications that SCOTT and COLLIE fraudulently acquired. The evidence at trial also showed that after obtaining the medications, SCOTT and COLLIE transported them to South Florida for sale on the so-called “gray market,” in which there is significant demand for such medications.

SCOTT and COLLIE were indicted on December 16, 2008. On June 4, 2009, COLLIE pleaded guilty to one count of conspiracy and one count of health care fraud charged in the indictment, and to a criminal information charging him with one count of health care fraud for a related scheme in which he participated between May and June of 2008, and cooperated with authorities. COLLIE’s sentencing is scheduled to take place before Judge Pannell tomorrow, Tuesday, December 15, 2009, at 10:00 a.m. The Publix pharmacist also cooperated with authorities and pleaded guilty to related charges in Gwinnett County Superior Court on January 13, 2009. The pharmacy technician was not charged in the scheme but cooperated with law enforcement. The pharmacies and the doctors also cooperated in the investigation.

The case was the culmination of a joint investigation conducted by the Federal Bureau of Investigation, Georgia Bureau of Investigation, Georgia Drugs & Narcotics Agency, Georgia Department of Community Health, and the Georgia Medicaid Fraud Control Unit. Valuable assistance was also provided by the Georgia State Patrol, Twiggs County Sheriff’s Office, Clayton County Sheriff’s Office, Gwinnett County Police Department, and the Florida Department of Law Enforcement.

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Conspirator in $12 Million Medicare Fraud Ring Sentenced to Prison

ALAIN AMADOR, 31, of Miami, Florida, was sentenced today by Senior United States District Judge Jack T. Camp to serve over 4 years in prison on a charge of conspiracy to commit health care fraud.

United States Attorney David E. Nahmias said, “This was a bold crime in which the defendant and his conspirators made up phony medical companies and billed Medicare for millions of dollars of fake medical services. This defendant, who was a key part of the scheme, will now spend several years in federal prison. The good news is that most of the money the conspirators attempted to get was either not paid or was seized by law enforcement. The crime was identified early because several Medicare patients carefully reviewed and reported discrepancies in the paperwork they received. We thank those citizens, who with many others are on the front lines in our battle against health care fraud.”

“We are proud to be part of the Federal team that brought AMADOR to justice," said Melody Jackson, Special Agent in Charge of the Office of Inspector General's Atlanta Regional Office, who also warned, “Criminals can rest assured that if they attempt to defraud federal health care programs and their patients, they will be held accountable.”

AMADOR was sentenced to 4 years, 3 months in prison to be followed by 3 years of supervised release, ordered to pay restitution in the amount of $3.9 million, and ordered to perform 200 hours of community service. AMADOR pleaded guilty to the charges on March 3, 2009.

According to United States Attorney Nahmias and the information presented in court: AMADOR and his conspirators set up a series of fake medical clinics in the Atlanta area. They leased space in the names of the companies, opened bank accounts, filed corporate documents in the names of the companies, and ultimately applied for and received Medicare billing numbers. However, the companies existed in name only. They maintained no operations, employees, or equipment. Using improperly obtained identity information of actual doctors and Medicare patients, the conspirators filed more than $12 million in Medicare claims for phony services in less than a year.

Of the amount billed, Medicare paid approximately $3 million before the scheme was uncovered and the payments were halted. As part of this criminal case, the United States seized approximately $2 million of this money, some of which was still present in bank accounts when the scheme was identified, and some of which was in the form of checks that were sitting in the fake offices waiting to be picked up and deposited. Most of the remainder of the money was transferred to or deposited in foreign bank accounts.

AMADOR, who has a nursing degree, helped set up and maintain the fake companies. He assisted in incorporating the companies and opening the bank accounts. He periodically traveled from Miami, where most of the conspirators were based, to Atlanta, to keep up appearances at the office space, check the mail (including picking up outstanding Medicare checks), and pay rent.

The investigation is still ongoing. One named co-defendant remains a fugitive. JESUS LLOSA, a Cuban national, was last known to live in Miami, Florida. This case was investigated by Special Agents of the Federal Bureau of Investigation and the Department of Health and Human Services, Office of the Inspector General.

Assistant United States Attorneys Justin S. Anand and Gerald S. Sachs prosecuted the case.

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