Share This Article:
Miami, FL (WorkersCompensation.com) - Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Assistant Attorney General Lanny A. Breuer of the Justice Department's Criminal Division, Michael B. Steinbach, Acting Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office announced that the co-owner and operator of three Miami discount pharmacies pleaded guilty yesterday in connection with a $23 million health care fraud scheme.
Jose Carlos Morales, 55, of Miami, pleaded guilty yesterday before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks.
According to court documents, Morales was the co-owner of Pharmovisa Inc., which operated two pharmacies in Miami, and PharmovisaMD Inc., which operated one pharmacy in Miami. Morales pleaded guilty to agreeing to pay illegal health care kickbacks to co-conspirators in return for a stream of beneficiary information to be used to submit claims to Medicare and Medicaid. The beneficiaries who were referred to Pharmovisa and PharmovisaMD (Morales pharmacies) in exchange for kickbacks payments resided at assisted living facilities (ALFs) located in Miami. Morales and his alleged co-conspirators also paid illegal health care kickbacks to physicians in exchange for prescription referrals, which the Morales pharmacies ultimately billed to Medicare.
Court documents also reveal that beginning in approximately 2007, at Morales' direction, drivers working for Morales pharmacies delivered “bingo cards” containing pop out medications to ALFs located throughout the Southern District of Florida, and Morales instructed these drivers to pick up any unused “bingo cards” so that Morales pharmacy personnel could place these medications back into pill bottles. Unused and partially used medications were eventually re-billed to Medicare and Medicaid, and a majority of the previously submitted claims to Medicare and Medicaid were never reversed. Morales also instructed Morales pharmacy personnel to place unused and partially used medications into bottles to be sold directly to the general public from the “community” pharmacy shelves.
In furtherance of the conspiracies, according to court documents, Morales and his alleged co-conspirators also engaged in sham financial transactions to facilitate and conceal the fraud schemes and the flow of fraud proceeds. In most instances, the sham transactions involved shell entities owned and/or controlled by Morales or his alleged co-conspirators.
On Oct. 16, 2012, Esperanza Navailles, a former “marketer” for the Morales pharmacies, pleaded guilty to conspiracy to defraud the United States and pay illegal health care kickbacks. From February 2011 to January 2012, Navailles, on behalf of the Morales pharmacies, paid ALF owners and operators $30 per patient per month for each Medicare beneficiary they referred to the pharmacies. The Morales pharmacies then submitted claims to Medicare for items and services on behalf of the referred Medicare beneficiaries. Navailles admitted that she knew the kickback payments were illegal.
According to court documents, Morales and his co-conspirators submitted and caused to be submitted approximately $23,367,755 in false and fraudulent claims to the Medicare and Florida Medicaid programs.
The cases are being prosecuted by Trial Attorney Allan J. Medina and Special Trial Attorney William Parente of the Criminal Division's Fraud Section. This 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, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
King of Prussia, Pa. (September 19, 2023) – MedRisk, the leader in managed physical rehabilitation in workers’ compensation, today announced the appointment of its President Sri Sridharan to Chief Executive Officer, effective immediately. As CEO, Mr. Sridharan will […]
- Sep 19, 2023
WorkCompCollege.com Launches Unique State-Specific Training Program for Workers’ Compensation Stakeholders
September 18, 2023 Lakewood Ranch, FL – WorkCompCollege.com, a division of Workers’ Compensation Educational Services, LLC, announced the launch of an innovative series of training modules covering the unique aspects of each workers’ compensation jurisdiction […]
- Sep 18, 2023
Las Vegas, NEV (September 7, 2023) – Since the pandemic, employers and workers’ compensation carriers have been refining their claims strategies to address the historic increase in anxiety, depression and substance abuse. “We have looked at […]
- Sep 12, 2023
About The Author
About The Author
More by This Author
ReEmployAbility, Inc.Contact: Rebecca Dearth(813) 261-3117 | email@example.com Brandon, FL (May 10, 2023)- ReEmployAbility CEO and Founder Debra Livingston will be hosting a second free, live Work Comp Central webinar in their continued series to educate […]
- May 11, 2023
(Orlando, FL–May 10, 2023)—The National Council on Compensation Insurance (NCCI) has given $25,000 to Kids’ Chance of America, supporting college scholarships for the children of injured workers. NCCI made the donation in conjunction with its Annual […]
- May 10, 2023
In response to a Medicare conditional payment demand, payers can access a five-level appeals process, including a hearing before a Centers for Medicaid and Medicaid Services (CMS) administrative law judge (ALJ). Most conditional payment demand […]
- Mar 30, 2023
- Sep 19, 2023
- Sep 18, 2023
- Sep 12, 2023
Brandon, FL (September 6th, 2023)- ReEmployAbility is happy to announce its sponsorship of The Spring of Tampa Bay’s Gift of Peace Luncheon. ReEmployAbility’s CEO and founder is a proud board member for the Spring of […]
- Sep 08, 2023
Wilmington, Mass. (September 5, 2023) — Ametros, which helps people manage their medical funds following workers’ compensation or liability settlements, has expanded its C-Suite with the promotions of two accomplished executives. As of September 1, Andrea […]
- Sep 06, 2023
August 31, 2023 (BOCA RATON, FL)—The National Council on Compensation Insurance (NCCI) celebrated 100 years of service to the workers compensation (WC) system with an event honoring its employees and a century of service to […]
- Sep 05, 2023