Healthcare News & Insights

2 clinic owners plead guilty to infusion therapy scheme

A husband and wife team, who owned clinics that claimed to specialize in treating HIV and other conditions, submitted millions of dollars in fraudulent claims to Medicare for infusion therapy. 

Now, they’re each facing a maximum potential penalty of 10 years in prison and a $250,000 fine.  Sentencing is currently scheduled for Feb. 12, 2013.

Raymond Arias, 40, and his wife, Emelitza Arias, 25, of Troy, MI, each pleaded guilty, before U.S. District Judge Paul Borman of the Eastern District of Michigan, to conspiracy to commit healthcare fraud.

According to plea documents, Raymond came up with and was the ringmaster for fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness, LLC, and Carefirst Occupational & Rehabilitation Center, Inc.  He admitted that he:

  • paid physicians to refer Medicare beneficiaries to Elite Wellness, and
  • purchased Medicare beneficiary identifications so he could submit fraudulent claims to Medicare for expensive infusion therapy services that weren’t rendered.

Dirty dealings

Court documents revealed that Raymond tried to cover up the Elite Wellness scheme by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited.  Then Raymond and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period, and had the nominee transfer approximately $2.6 million in Medicare payments offshore to Panama and Mexico.

In total, in about a year’s time, the scheme netted approximately $5.4 million from Medicare for $12.5 million in fraudulent claims for infusion therapy services never rendered.

Court documents also revealed that Emelitza helped her husband with an infusion therapy scheme to defraud Medicare through Carefirst, of which she was an owner.  To create an appearance that Carefirst was a legitimate business, Emelitza injected Medicare beneficiaries with vitamins.  She also assumed responsibility for the claims submitted by Carefirst, and managed the bank account into which the fraudulent proceeds were deposited.

The couple and their alleged co-conspirators at Carefirst submitted more than $900,000 in fraudulent claims to Medicare for infusion therapy services not rendered and were paid $530,000 from Medicare.

 

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