Home Health & Hospice Week

Suppliers face possible decades of jail time.

If you furnish orthotics, you can bet your claims are getting very careful scrutiny.

The HHS Office of Inspector General has indicated orthotics are an area of fraud and abuse concern, and recent grand jury indictments in Florida seem to bear that out.

Nine individuals, including five family members, are accused of running a complicated fraudscheme through 12 durable medical equipment companies. The suspects fraudulently billed for pricey custom orthotics and other medical services that weren't medically necessary, alleges Marcos Daniel Jimnez, U.S. Attorney for the Southern District of Florida.

Prosecutors charge "that the defendants paid kickbacks to patient recruiters who would, in turn, bribe Medicare beneficiaries to serve as fictitious patients for the medical equipment companies," according to a release.

The $14.5 million in Medicare reimbursement the DME companies took in between January 2000 and December 2002 was all due to false claims, Jimnez contends. Those fraudulent claims were also for items such as hospital beds and oxygen.

The DME company owners -- Ruben Martinez; his daughter, Adriana Ramos; her husband, Daniel Ramos; Ruben Martinez's son, Daniel Martinez; and Ruben Martinez's mother, Edith Martinez -- used their ill-gotten gains to purchase property, expensive jewelry and a Porsche Boxter, prosecutors charge.

The Martinezes, the Ramoses, medical clinic owner Stephanie Smith, billing company worker Miraidy Gonzalez, bank employee Hilda Garcia and family friend Emilio Seijo face a range of charges from health care fraud to money laundering, Jimnez says. The most serious charges carry up to 20 years in prison.

The 12 DME companies closed in December 2002. That month, the U.S. Attorney's Office filed a civil injunction and froze $900,000 in the Martinez's and Ramos's bank accounts.

The OIG, the AG, the Federal Bureau of Investigation and the Internal Revenue Service investigated the case.