Miami physician sentenced to 30 years in prison for role in $11 million Medicare fraud scheme

This material originally appeared in the December 19, 2008, issue of Health Lawyers Weekly, a publication of the American Health Lawyers Association (www.healthlawyers.org).

A Miami physician was sentenced to 30 years’ imprisonment for her role in an $11 million Medicare fraud scheme involving HIV-infusion clinics, according to a press release issued December 18 by the U.S. Attorney for the Southern District of Florida R. Alexander Acosta. 

“The 30-year prison sentence is one of the longest terms ever given to a physician in a federal Medicare fraud case,” the release said. 

The physician, Ana Alvarez-Jacinto, worked at St. Jude Rehab Center, Inc. (St. Jude), a clinic that purported to specialize in treating AIDS patients with HIV-infusion therapy. St. Jude was one of multiple clinics owned and operated by Carlos and Luis Benitez, who also have been convicted for their roles in developing and executing the massive $100 million Medicare fraud scheme, according to the release. 

Evidence presented at trial demonstrated that Alvarez-Jacinto, with the assistance of nurse and co-conspirator, Sandra Mateos, ordered hundreds of medically unnecessary HIV-infusion treatments at the clinic from June to November 2003. Mateos also was sentenced December 18 to seven years’ imprisonment, the release noted. 

In the fraud scheme, HIV-positive Medicare patients were brought to St. Jude by the Benitez brothers for the purpose of receiving cash payments in exchange for allowing the clinic to bill for unnecessary treatments. Mateos and other co-conspirators would then pay the patient cash kickbacks of $150 per visit. 

After the patient was paid, they agreed to allow Alvarez-Jacinto and her co-conspirators to prescribe and administer unnecessary infusion treatments, which were then billed to Medicare. Over the five-month period, Medicare ultimately paid more than $8 million to the clinic. 

“False billing to Medicare for services not delivered is a serious crime that depletes our limited Medicare dollars,” commented Acosta in the release. “Far worse, however, is when medical professionals like the doctor and nurse sentenced today, actually order and perform medically unnecessary treatments to pad bills and make more money.” 

The sentencing judge also ordered Alvarez-Jacinto and Mateos to serve three years’ supervised release following their prison terms and pay $8.3 million in restitution to the Medicare program.