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Nearly two dozen people have been charged for their involvement in a multi-million dollar Medicare fraud scheme that took place at two Miami pharmacies over the course of several years.
A total of 19 suspects are facing charges including organized fraud, racketeering, grand theft and money laundering, according to arrest warrants released Tuesday.
The scheme made use of professional beneficiaries, which are people who allow their Medicare benefits to be exploited by fraudsters in exchange for monetary compensation, the warrants said.
In this case, the professional beneficiaries involved were receiving up to 30 percent of the profits from each medication that was fraudulently billed by either Santander Pharmacy or Wynwood Family Pharmacy Corporation, the warrants said.
The beneficiaries would visit doctors in order to acquire prescriptions for medications they did not need. The prescriptions would be taken to Santander or Wynwood pharmacies, where the drugs would be charged to Medicare even though the drugs would never actually be dispensed or received.
The drugs that were fraudulently billed tended to be highly expensive, such as anti-psychotic drugs, according to the arrest warrants.
Since the opreation began in Santander Pharmacy in 2015, more than $4 million in federal funds has been stolen using this method.
According to the arrest warrants, South Florida leads the country in this kind of Medicare fraud, particularly Miami-Dade and Broward counties. Individuals establish a pharmacy by submitting corporate documents and obtaining a pharmacy license from the Florida Department of Health, and then commit fraud by submitting claims to Medicare for services that are never actually rendered or needed.
Santander Pharmacy was established in September of 2014 with Ines Santander as its sole owner. After she had difficulty obtaining documents that would allow the pharmacy to bill Medicare, she enlisted Ingrid Perdomo as her co-owner.
Perdomo’s husband, Stirlitz Pio Diaz, was subsequently brought in to assist with the business, and he enlisted Luiba Rodriguez Leyva to be the pharmacy technician in charge of billing.
With help from their professional beneficiaries, these conspirators managed to submit over $788,000 worth of claims to Medicare for prescription drugs, $382,000 of which was paid to the pharmacy.
According to the arrest warrants, investigations revealed that at least $183,170 of that amount was for medically unnecessary prescription drugs that Santander never purchased or dispensed.
Disagreements led the group of conspirators to split up, and according to the arrest warrants, Santander claimed that Pio Diaz ended up stealing several thousand dollars from the company account before they parted ways.
In May of 2016, Pio Diaz added himself and his wife Perdomo to Wynwood Pharmacy as the new owners, taking it over from Jose G. Martin.
Under Martin, Wynwood Pharmacy had billed over $574,000 to Medicare. When Pio Diaz and Perdomo took over, they continued to aggressively bill Medicare, and the pharmacy received over $434,000.
In total, since August of 2015, over 25,000 claims were charged to Medicaire under Martin, Pio Diaz and Perdomo, amounting in over $4 million being stolen from federal funds through Wynwood Pharmacy.
According to the arrest warrants, investigations found that the pharmacy had a network of relationships with patient brokers, or people who recruit professional beneficiaries to partake in the scheme.
When Pio Diaz took over as the owner, he brought with him several of the employees he had worked with at Santander, including Leyva, as well as all of the beneficiaries who had partaken in the scheme at Santander. He also enlisted Diana Cabrera as a pharmacy technician and Katia Ramirez as a patient broker.
Wynwood Pharmacy also used the personal information of a particular doctor without their knowing.
According to the arrest warrants, throughout the course of the scheme several audits conducted found major discrepancies in the operations of Santander and Wynwood pharmacies, including gross shortages in medications purchased compared to those dispensed, as well as doctors claiming misuse of information.
In 2017, Wynwood Pharmacy billed a total of $1,717,24 to Medicare, $1,269,333 of which was received by the pharmacy. In 2018, over $5 million was billed, and over $1.6 million received.
In 2019, the amount Wynwood received was again close to reaching the $1 million mark.