THREE CHARGED IN MEDICARE FRAUD SCHEME IN CONNECTION WITH MIAMI-DADE PHYSICAL AND OCCUPATIONAL THERAPY CLINICS
Jeffrey H. Sloman, United States Attorney for the Southern District of Florida, and John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation, announced today that defendant Ernesto Angel Montaner, formerly of Miami-Dade County, was indicted on April 22, 2010 on charges of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349, and multiple counts of health care fraud, in violation of 18 U.S.C. § 1347. Last week, the United States Attorney filed a related Information against Ernesto Angel Montaner’s son, Ernesto Montaner, and co-conspirator, Jose Antonio Varona. They were both charged with conspiracy to commit Medicare fraud, in violation of Title 18, United States Codes, Section 1349.
The indictment alleges that Ernesto Angel Montaner and his son, Ernesto Montaner, together with other conspirators, operated and controlled multiple physical and occupational therapy (PT/OT) clinics, including Infinity Therapy Inc., Mega Therapy Center, Inc., and Miami Dade Medical Group, Inc. The Montaners, together with Jose Antonio Varona, also controlled a fourth PT/OT clinic, known as Florida Rehabilitation Clinic, Inc.
The indictment alleges that Ernesto Angel Montaner and Ernesto Montaner made periodic cash kickback payments to patient recruiters, and to an undercover law enforcement officer posing as a patient recruiter, in return for the referral of Medicare beneficiaries for PT/OT services. The indictment further alleges that Ernesto Angel Montaner, Ernesto Montaner, and Jose Antonio Varona paid periodic cash kickbacks to the owners of assisted living facilities, home health agencies, and other medical facilities, all of whom referred Medicare beneficiaries to Infinity Therapy, Mega Therapy, or Florida Rehabilitation Clinic for PT/OT services.
According to the indictment, the conspirators paid the kickbacks without regard to the Medicare beneficiaries’ actual medical condition, and without regard to whether PT/OT services were medically necessary. The indictment further alleges that, to conceal certain kickback payments, defendants Ernesto Angel Montaner and Ernesto Montaner issued checks from Infinity Therapy payable to JAV Consulting, a shell corporation controlled by defendant Varona, or to other shell corporations controlled by Varona's personal associates. Thereafter, Varona allegedly used the funds to make illegal cash kickback payments to patient recruiters, and to the owners of various medical facilities.
In addition, according to the Information filed last week, the conspirators defrauded the Medicare program in various ways. First, the conspirators submitted fraudulent claims to Medicare on behalf of Infinity Therapy, Mega Therapy, Miami Dade Medical and Florida Rehabilitation Clinic for PT/OT services rendered by unlicensed and unqualified physical therapists, occupational therapists, and therapy assistants. Second, the conspirators submitted false claims to Medicare for PT/OT services allegedly rendered to Medicare beneficiaries who, unbeknownst to the Montaners, were actually cooperating government witnesses. Third, after February 2008, when a complicit supervising physician working for Ernesto Angel Montaner died of natural causes, the conspirators continued to submit claims to Medicare for PT/OT services that were primarily overseen by a “physician” who was not actually licensed in the United States. Fourth, the conspirators created “billing templates” that were designed to ensure that Medicare was typically billed for at least seventeen PT/OT sessions, using an optimized set of predetermined billing codes, regardless of how many times the Medicare beneficiary actually visited the clinic, and regardless of the Medicare beneficiaries’ actual health. The conspirators also used certain billing codes, known as “modifier codes,” to bypass Medicare’s normal annual financial limits for PT/OT services. Based on these schemes and others described in the charging documents, the conspirators submitted more than $2.5 million of false claims to Medicare.
On April 22, 2010, the United States filed a notice with the court stating that Ernesto Angel Montaner fled the United States in or around February 2009. If convicted, the defendants face a maximum statutory term of imprisonment of 10 years on Count 1 and 10 years on Counts 2-7.
Mr. Sloman commended the investigative efforts of the Federal Bureau of Investigation. In addition, the U.S. Attorney’s Office thanks Metropolitan Property & Casualty Insurance, 21st Century, and National Insurance Crime Bureau for their cooperation in this investigation. This case is being prosecuted by Assistant U.S. Attorney Ryan Stumphauzer.
An Indictment is only an accusation and a defendant is presumed innocent until and unless proven guilty.
Attachments:
Indictment (PDF)
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.
