Miami Woman Sentenced To Prison For Role In $750,000 Medicare Fraud Scheme

A woman from Miami, Florida was sentenced to 30 months in prison on Jan. 15 for her role in a $750,000 health care fraud scheme involving six Miami-area home health agencies, Sunshine Home Health Services Inc., Empire Home Health Agency Inc., A&C Home Health Care Inc., Healthylife Home Car, Humanity Home Health and ACM Home Health Corp., which purported to provide home health services to Medicare patients.   

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Milena Gonzalez, 54, of Miami, was sentenced by U.S. District Judge Jose E. Martinez of the Southern District of Florida.  Judge Martinez also ordered Gonzalez to pay $478,560.54 in restitution and to forfeit $346,595.00.  Gonzalez pleaded guilty on Oct. 24, 2018 to one count of conspiracy to defraud the United States and to pay and receive health care kickbacks. 

As part of her guilty plea, Gonzalez admitted that from approximately November 2010 through approximately September 2015, she accepted kickbacks in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services, to serve as patients of the six agencies.  Gonzalez further admitted that in addition to receiving kickbacks, she paid kickbacks to the owners and operators of a medical clinic called City Rehab Corp., in return for prescriptions for home health services for her recruited Medicare beneficiaries. 

The defendant admitted that, as a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of at least approximately $750,000.

Gonzalez was charged along with Nelson Anzardo Calzadilla, 55, of Miami, in an indictment returned on June 15, 2018.  Nelson Anzardo Calzadilla pleaded guilty to conspiracy to commit health care fraud and wire fraud and is scheduled for sentencing in February 2019.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.  Former Fraud Section Trial Attorney and current Assistant U.S. Attorney Leslie Wright prosecuted the case; the case is now being handled by Trial Attorney Emily Gurskis of the Fraud Section.

The Criminal Division’s Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.