Miami Physicians Confess to Scam Medicare of $6.8 Million

Miami physicians Carlos Contreras and Ramon Pichardo pled guilty last week to defrauding the Medicare program in connection with a $6.8 million HIV infusion fraud scheme.

Contreras admitted that, from November 2002 through April 2004, he conspired with others to submit approximately $6.8 million in fraudulent Medicare bills, he signed documents containing false information about treatments purportedly given to HIV-positive patients and he approved medically unnecessary treatments at CNC.

He also admitted that the clinic received approximately $4.2 million from the Medicare program as a result of his and his co-conspirators' conduct. In November of 2002, Contreras entered into an agreement with Carlos Benitez, Luis Benitez, Thomas McKenzie, Pichardo and others to operate CNC as a fraudulent HIV infusion clinic.

According to federal officials, Contreras admitted that the Benitez brothers would refer HIV-positive Medicare beneficiaries to the clinic, provide staff members to work at the clinic and transport patients to CNC in exchange for a substantial share of CNC's profits.

In addition, they said, Contreras was aware that the patients referred to CNC by the Benitezes were paid cash kickbacks in exchange for visiting the clinic and allowing their names to be used to bill the Medicare program. He also agreed to approve expensive and medically unnecessary HIV infusion claims at the clinic, and to falsify medical records.

Medicare Fraud Prevention

Medicare fraud costs the government millions of dollars! Losses create higher premiums, deductibles, and co-payments. They can also prevent Medicare from offering more services and better coverage.

Medicare fraud can be found in many types of billings. For example:
- Medicare Part A (nursing homes, residential facilities, hospitals and hospices)
- Medicare Part B (physician services)
- Medicare Part C (medicare advantage or Part D prescription drug benefit)
- Durable Medical Equipment suppliers

Preventive measures can be performed by:
- Thoroughly reviewing the explanation of Medicare Benefits or Medicare Summary Notice
- Protecting your Medicare card number
- Asking questions
- Reporting suspected fraud or abuse