Highbridge News

$31 Million Bilked in Medicaid Mills

BRONX, NEW YORK (BRONX NEWS)- A man was convicted of running fraudulent Bronx Medicaid mills that bilked the government out of $30 million and give HIV patients watered down meds.

Preet Bharara, the United States Attorney for the Southern District of New York, announced that Oscar Huachillo, the former owner and operator of multiple HIV/AIDS clinics in New York City, was sentenced in Manhattan federal court to 87 months in prison for orchestrating a scheme to defraud Medicare out of more than $31 million; he was also sentenced to 60 months in prison, to be served concurrently, for evading more than $3.4 million in federal income taxes by falsely underreporting his income.

As part of the scheme, Huachillo submitted bills to Medicare for expensive treatments that were administered at highly diluted doses or never administered at all, and were often unnecessary. Huachillo previously pled guilty to conspiring to commit health care fraud and committing tax evasion before U.S. District Judge Katherine Polk Failla, who imposed today’s sentence.

Manhattan U.S. Attorney Preet Bharara said: “Oscar Huachillo defrauded Medicare out of tens of millions of dollars and evaded millions of dollars in taxes on his illegal windfall. His schemes put patients at risk, undermined and exploited the Medicare program, and cheated honest taxpayers.”

According to the criminal complaint, superseding information, and other documents filed in Manhattan federal court, as well as statements made at related court proceedings:

Huachillo set up and operated multiple health care clinics in New York City that purported to provide injection and infusion treatments to Medicare-eligible HIV/AIDS patients, but that were, in reality, health care fraud mills (the “Clinics”) that routinely billed Medicare for medications that were never provided or were provided at highly diluted doses, and that were often unnecessary because the person being “treated” did not medically need the treatments.

Huachillo and his co-conspirators executed the fraudulent scheme by recruiting HIV/AIDS patients who were eligible for Medicare to come to the clinics multiple times per week, for multiple months, to undergo expensive “treatments” that were often unnecessary. The purported treatments included drugs costing hundreds of dollars each to administer and typically reserved for cancer and anemia patients. Huachillo and his co-conspirators paid the patients cash kickbacks of up to $300 per week in exchange for coming to the clinics and agreeing to undergo the treatments. Patients were also offered approximately $50 for each additional patient they referred to the clinics. Huachillo and his co-conspirators then used these patients’ status as Medicare beneficiaries to submit claims to Medicare for reimbursement for the treatments purportedly administered to the patients, often receiving tens of thousands of dollars in reimbursements per patient. As a result of the scheme, from 2009 through 2013, Huachillo and his co-conspirators defrauded the Medicare system out of at least $31 million.

In addition, Huachillo willfully evaded over $3.4 million in taxes owed to the IRS during the tax years 2009 through 2011 by falsely underreporting his taxable income, including income he had obtained through fraudulent Medicare claims.

In pronouncing the sentence, Judge Failla said, “[I]n the cases I’ve had as a judge, this is the worst fraud I’ve had. $31 million in losses; that’s terrible.” She also said, “The conduct is simply reprehensible.”

In addition to the term of prison, Huachillo, 55, of Manhattan, was sentenced to three years of supervised release and was ordered to pay $3,454,244.16 in restitution and $31,177,987.84 in forfeiture, including forfeiture of approximately $14 million of assets that were seized at or around the time of Huachillo arrest in August 2013.

George Juvier, 58, of Manhattan, has been charged separately in connection with the Medicare fraud scheme. In January 2015, Juvier pled guilty to engaging in a health care fraud conspiracy before U.S. Magistrate Judge Frank Maas. Juvier is scheduled to be sentenced at 11:00 a.m. on October 8, 2015, by U.S. District Judge Kimba M. Wood.

Mr. Bharara praised the outstanding efforts of the Department of Health and Human Services-Office of the Inspector General, IRS-Criminal Investigation Division, and the Federal Bureau of Investigation in the investigation. Mr. Bharara also thanked the U.S. Department of Justice’s Tax Division for their assistance in the investigation.

This case is being handled by the Office’s Complex Frauds and Cybercrime Unit. Assistant U.S. Attorney Jonathan Cohen is in charge of the prosecution.

#Medicaid #Fraud #MedicaidMills #HIV

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