Medicare Fraud earns Dr. Rene De Los Rios 235 months in Federal Prison. Comments by Ethics and Fraud Prevention speaker Chuck Gallagher

July 7, 2011

The following is a news release from the Department of Justice.  Please note – EVERY CHOICE HAS A CONSEQUENCE!  As an ethics and fraud prevention speaker to numerous governmental agencies including the FBI – it is clear that regardless of how clearly wrong choices like this may be, the fact remains that unless there are safeguards put in place to remove one of the three components that allow an ethics person to make unethical and illegal choices, we will continue to have frauds like this and the consequences that follow.

If you know of Dr. Rene De Los Rios and have insight into the doctors thinking…feel free to share your comments below!

WASHINGTON – Miami doctor Rene De Los Rios, 72, was sentenced today to 235 months in prison for his participation in a $23 million HIV injection and infusion Medicare fraud scheme , announced the Departments of Justice and Health and Human Services (HHS).

U.S. District Court Judge Joan A. Lenard of the Southern District of Florida also sentenced De Los Rios to three years of supervised release following his prison term and ordered him to pay a minimum of $11.7 million in restitution, jointly with his co-defendants.  The final amount of restitution will be determined at a later hearing.   On April 14, 2011, De Los Rios was convicted by a jury of one count of conspiracy to commit health care fraud and four counts of submission of false claims.  De Los Rios was remanded to the custody of the U.S. Marshals Service after his conviction and has been detained since that time.

According to evidence presented at trial and sentencing, De Los Rios worked at multiple fraudulent medical clinics and signed medical documents authorizing tests and treatments that were medically unnecessary or never provided.   The court found De Los Rios responsible for a total of $46 million in fraudulent billings to Medicare.

According to evidence presented at trial, De Los Rios was hired by the owner of Metro Med of Hialeah Corporation, an HIV infusion clinic that purportedly provided injection and infusion therapies to HIV-positive Medicare beneficiaries.   Evidence presented at trial established that De Los Rios ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments to make it appear that legitimate medical services, including injection and infusion therapies, were being provided to Medicare beneficiaries at Metro Med.  However, the injection and infusion therapies were medically unnecessary and never provided.   De Los Rios also signed medical charts, often without seeing the patient, indicating that certain treatments were medically necessary, when, in fact, he knew they were not.

Evidence at trial established that De Los Rios diagnosed almost all of the patients at Metro Med with the same rare blood disorders, which the patients did not have, in order to ensure maximum reimbursement from Medicare.  The evidence at trial also showed that De Los Rios prescribed expensive medications, including Winrho, Procrit and Neupogen, to patients for the sole purpose of receiving reimbursement from the Medicare program.  From approximately April 2003 through October 2005, Metro Med submitted approximately $23 million in claims to the Medicare program for injection and infusion treatments that were not medically necessary and were never provided.  The Medicare program paid approximately $11.7 million in claims.

The owner and operator of Metro Med, Damaris Oliva, and three other individuals have each pleaded guilty for their roles in the Metro Med fraud scheme.   Oliva was sentenced in December 2010 to 82 months in prison.   Co-defendants Estrella Rodriguez, Jose Diaz and Lisandra Aguilera were sentenced to 57 months in prison, 54 months in prison and 70 months in prison, respectively.

Evidence at trial and sentencing also established that De Los Rios engaged in almost identical conduct at additional sham HIV injection and infusion therapy clinics in South Florida during the same time period.  At J&F Community Medical Center Inc.  and Rochris Medical Center Inc., De Los Rios prescribed the same medications that he prescribed at Metro Med to patients who he knew did not need them.

In a two-and-half-year period, De Los Rios made more than $587,000 in profits from the fraud schemes.

At sentencing, the court also found that De Los Rios obstructed justice by testifying falsely at his trial; that as a doctor, De Los Rios occupied a position of trust, which he violated; and that by prescribing medically unnecessary injections and infusions for HIV-positive patients, De Los Rios caused a reckless risk of serious bodily injury to those patients.

The court declared a mistrial in De Los Rios’ first trial in March 2011.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case was prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section and Robert J. Luck, Assistant U.S. Attorney for the Southern District of Florida.   The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants and organizations that collectively have billed the Medicare program for more than $2.3 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov .

YOUR COMMENTS ARE WELCOME!


Federal Government Job Opportunities for Inner City Youth – Ebonics a must!

August 24, 2010

On AUGUST 23–The Department of Justice published an article stating that it “is seeking to hire linguists fluent in Ebonics to help monitor, translate, and transcribe the secretly recorded conversations of subjects of narcotics investigations, according to federal records.”

The article caught my attention and I must admit I began to laugh – at first.  Having spent time in federal prison (not something I am proud of) I know the frustration of dealing with a second language.  As a white well educated male I found quickly that I did not possess the language skills needed to successfully navigate the time before me I was to spend in prison.  I knew English and fractured “Southern” – red neck some folks would call it.  What I did not know was Spanish and – more importantly – Ebonics.

When my cell mate spoke first to me – asking me what I was in here “fo”?  I responded, “I’m a theif.”  His response was “Word?”  I suppose I looked dumbfounded as I repeated what he said back to him with a questioning look.  “Word?”  Now to read this doesn’t do it justice.  You have to have the dialect and intonation to get the message.  In short, we weren’t communicating.

Then Buck – that was my cell mates name.  Buck and Chuck – don’t know if the guards did that for comic relief, but we did make a good pair.  Anyway, Buck, realizing the lack of communication said he’d make me a deal.  He’d teach me Ebonics (and/or how to survive in prison) if I’d teach him “how to speak correctly” so he could get a real job when he got out.  Deal!

But back to Federal Government Job Opportunities…

The article goes on to state:

A maximum of nine Ebonics experts will work with the Drug Enforcement Administration’s Atlanta field division, where the linguists, after obtaining a “DEA Sensitive” security clearance, will help investigators decipher the results of “telephonic monitoring of court ordered nonconsensual intercepts, consensual listening devices, and other media”

The DEA’s need for full-time linguists specializing in Ebonics is detailed in bid documents related to the agency’s mid-May issuance of a request for proposal (RFP) covering the provision of as many as 2100 linguists for the drug agency’s various field offices. Answers to the proposal were due from contractors on July 29.

Ebonics has widely been described as a nonstandard variant of English spoken largely by African Americans. John R. Rickford, a Stanford University professor of linguistics, has described it as “Black English” and noted that “Ebonics pronunciation includes features like the omission of the final consonant in words like ‘past’ (pas’ ) and ‘hand’ (han’), the pronunciation of the th in ‘bath’ as t (bat) or f (baf), and the pronunciation of the vowel in words like ‘my’ and ‘ride’ as a long ah (mah, rahd).”

O.K. it’s funny to read or try to read how white folks describe and write Ebonics…sorry, but this just cracks me up…!

The Department of Justice RFP does not, of course, address questions of vernacular, dialect, or linguistic merit. It simply sought proposals covering the award of separate linguist contracts for seven DEA regions. The agency spends about $70 million annually on linguistic service programs, according to contract records.

In addition to the nine Ebonics experts, the DEA’s Atlanta office also requires linguists for eight other languages, including Spanish (144 linguists needed); Vietnamese (12); Korean (9); Farsi (9); and Jamaican patois (4). The Atlanta field division, one of the DEA’s busiest, is the only office seeking linguists well-versed in Ebonics. Overall, the “majority of DEA’s language requirements will be for Spanish originating in Central and South America and the Caribbean,” according to one contract document.

The Department of Justice RFP includes a detailed description of the crucial role a linguist can play in narcotics investigations. They are responsible for listening to “oral intercepts in English and foreign languages,” from which they provide verbal and typed summaries. “Subsequently, all pertinent calls identified by the supervising law enforcement officer will be transcribed verbatim in the required federal or state format,” the RFP notes.

Additionally, while “technology plays a major role in the DEA’s efforts, much of its success is increasingly dependent upon rapid and meticulous understanding of foreign languages used in conversations by speakers of languages other than English and in the translation, transcription and preparation of written documents.”

So here’s the deal…

If the government is truly serious about hiring folks to have a legitimate job helping with Ebonics…they should look to the inner city youth, inmates being released from prison or other folks who find Ebonics their first language and English (or talking to white folks) their second language.  And if readers think I’m kidding…I’m not.  Why not go to Detroit or inner city Miami or other Ebonics hot spots and offer a job to someone who otherwise might find themselves on the wrong side of the law some day.

If Frank Abagnale (of Catch Me If You Can – the movie – fame) can turn crime into crime stopping support – so can inner city youth.  Let’s put stimulus dollars to work in a productive way.

YOUR COMMENTS ARE WELCOME!


O J Simpson’s Self Sabatoge – You Can’t Escape the Law – You Reap What You Sow!

January 14, 2008

Have you ever noticed that it’s impossible to avoid outcomes that – on the surface you would think – you want to avoid. Oh, for a time, you might think you could dodge the bullet, but then reality hits and, once again, you are hit squarely in the face with reality. For O. J. Simpson that rings true.

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Reality is – O. J. Simpson is sabotaging himself.

No I’m no psychologist so I have no formal educational basis for my claim and even though I state that here, I am sure I’ll receive comments to that effect. But, I do have a Ph.D. from the school of practical experience. And, let me say, that is one of the most significant learning environments I’ve ever participated in. So let me state again my premise – O. J. Simpson is sabotaging himself!

The question is why? Why would anyone take actions – either consciously or unconsciously – that would bring about an outcome that, by most standards, people would not want?

Why, for example, would you violate the terms of your bail knowing that such a violation would, most certainly, put you in jail?

The Theory:

We are taught in school several laws which we hold to be truth. One is that, on a universal level, everything seeks to find equilibrium. For example, I am a private pilot and one of the first lessons was that a plane (airplane) seeks to fly, so if you are in an unnatural attitude – let go of the controls and the plane will generally right itself. Similarly, for every action there is an equal and opposite reaction. One might try to delay the outcome or reaction, but it is inevitable.

O.K. – so much for theory. How does that apply to O. J.? Well, O. J. got off from his earlier murder charge. Recall, if the glove don’t fit, you must acquit! Verdict: Not Guilty!

Now for most of us…that little (O.K. Big) brush with the law would be enough. But, O. J. couldn’t resist. He had to try to get his stuff. Slogan: The theft is fine, if the stuff is mine! (Sorry, couldn’t resist that one). Outcome: Busted for armed robbery. Hum…in trouble again. Now why would you even try to (get your stuff back) knowing that you could have an issue with the law?

But…that’s not enough. Simpson had been instructed by Las Vegas Justice of the Peace Joe M. Bonaventure in September not to have any contact with anyone involved in the case — not even by “carrier pigeon.” So what does Simpson – violate the terms of bail. Another dumb move.

Or is it?

Self Sabotage:

If one is guilty of a crime, then one will continue to do things so that guilt is brought to light. While Simpson got past the murder charge, there is something lurking that brings Simpson the need for punishment. So, having avoided what some would call his just reward, O. J. has chosen to act out in different ways so that equilibrium is restored. O. J. is guilty of something and the need for punishment is being manifest by his actions – whether conscious or unconscious.

A universal law is at work here – you will reap what you sow! And, until that law is satisfied, you will continually have the opportunity to reap till there is equilibrium.

The Positive Side of Consequences:

While reaping and sowing, at least in O. J.’s case, seems to focus on the negative, I know from experience that one can experience negative consequences from one’s actions, but likewise, you can enjoy positive results from the seeds you sow. From prison to Senior Sales Executive in a public company – I know that first hand from personal experience and speak about it regularly. If you’re interested in my presentations visit my web site at http://www.chuckgallagher.com

Perhaps, once O. J. is past this phase of his life and has satisfied his need for punishment, he’ll have the time to pay it forward and give back using his celebrity for the benefit of others. Till then – mark my words – a universal law is in play and once started it will find balance.