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Legal Speak

Holy Cow: I Can't Believe I Stole The Whole Thing!

Published April 20, 2010 10:01 AM by Tony DeWitt

Have you ever wondered if you went into the wrong side of health care? Nurses and aides working 12 to 14 hour days taking care of the elderly earn their living the old fashioned way. By the sweat of their brow and the ache in their joints at the end of the day, they leave work with the knowledge that, at the least, someone is feeling better because they were there. 

Go into any nursing home and you won't find a nurse wearing a Rolex wristwatch. Go to the employee parking lot and you won't find a Lomborghini Gallardo or a Ferrari Scaglietti. And for most nurses, at the end of the day, their bank balances are not in the six figures.

But for some, the business of health care has been like walking into a bank without guards and helping yourself to the money. Ihosvany Marquez is one such person. Through a number of shell businesses Marquez submitted more than $55,000,000 in false Medicare claims to the United States government. What is amazing is how he did it.

In the typical Medicare false claim scheme the defendant is a doctor. After four years of college, four years of medical school, and more than three years of residency, the doctors find that the economics of medical practice is not as they imagined. As a result, they take shortcuts or they get into arrangements where they exchange patient referrals for money. In one instance that our office handled, an ambulance company worked out agreements with nursing homes to swap free rides in exchange for Medicare transports. The claims were false because the parties violated the Anti-Kickback statute. But it is worth noting that patients were transported. Medicare paid for a service that was actually provided, but provided in violation of the rules.

Not so in south Florida where a group of con artists set up a scheme both so simple and so clever that it avoided detection for years. First, they recruited a number of Cuban nationals -- persons who enjoyed Cuban citizenship but were lawfully in the country -- to be the nominal owners of several of their businesses. These businesses included things like medical supply warehouses, clinics, and infusion therapy centers. Absent from these clinics and therapy centers were actual patients. 

The defendants set up the schemes with the purchased names and other personal identifying information of Medicare beneficiaries. They also purchased the names and UPIN numbers of a bunch of physicians in the Miami area so as to generate false medical orders, and false signatures on claims forms.  These names and identification numbers were then used  to generate millions of claims to Medicare for infusion therapy for AIDS/HIV, cancer, and vascular disorders that were never done.

Marquez used approximately $2.7 million for the proceeds from the fraud scheme to purchase luxury vehicles for himself and for his family members. Marquez bought several Lamborghinis, a Ferrari, two Bentleys, and eight assorted Mercedes Benz automobiles. What he could not spend on cars, he spent on luxury living accommodations, and laundered through corporations named for Santiera saints. 

Marquez, who was a pitching star in high school and recruited by the Baltimore Orioles in the 1990s, is now facing a thirty year prison sentence. But before the federal agents caught up to him, many of his employees and much of the money he stole skipped town for Cuba. 

Under the new Health Care Reform Act employees who report fraud like Marquez engaged in stand to reap significant benefits under the False Claims Act. It would sure be nice to see nurses and nurse aides pocketing money recovered from scam artists. And it would be even nicer to find a good shortstop to play with Mr. Marquez on the federal prison team.

posted by Tony DeWitt
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About this Blog

    A.L. "Tony" DeWitt, RRT, CRT, JD, FAARC
    Occupation: Attorney
    Setting: Jefferson City, Mo.
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