Detroit Clinic Owners Plea in $22M Medicare Scam
WASHINGTON – Two Detroit-area clinic owners pleaded guilty to their roles in a brazen infusion therapy scheme that bilked Medicare out of $22 million.
Raymond Arias, 40, and his wife Emelitza Arias, 25, of Troy, Mich., each copped to one count of conspiracy to commit healthcare fraud before U.S. District Judge Paul D. Borman of the Eastern District of Michigan. At sentencing, the couple faces a maximum potential penalty of 10 years in prison and a $250,000 fine.
According to plea documents, Raymond Arias conceived of and oversaw fraud schemes at two clinics for which he was a beneficial owner: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc. He admitted to paying physicians to refer Medicare beneficiaries to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.
Raymond Arias also attempted to hide the Elite Wellness scheme from law enforcement by directing a nominee owner to assume control of the claims submitted and the bank account into which Medicare payments were deposited. After the nominee owner became involved, Raymond Arias and his alleged co-conspirators submitted approximately $10 million in claims over a 3-month period beginning in August 2010. He directed this nominee to transfer approximately $2.6 million in Medicare payments offshore to Panama and Mexico.
Between approximately October 2009 and October 2010, Raymond Arias admitted, he and his alleged co-conspirators at Elite Wellness submitted or caused to be submitted approximately $12.5 million in fraudulent claims to the Medicare program for infusion therapy services that were not rendered. Medicare paid approximately $5.4 million of those claims. The scheme continued at Carefirst, where the couple and their alleged co-conspirators submitted or caused to be submitted more than $900,000 in fraudulent claims to the Medicare program for infusion therapy services that were not rendered. Medicare paid approximately $530,000 of those claims.
This case is being prosecuted by Assistant U.S. Attorney Philip A. Ross of the Eastern District of Michigan and Trial Attorney Catherine K. Dick of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force.
The guilty pleas are a blow to the alleged co-conspirators, who stand to face significant prison time and fines for their roles in the massive Medicare scam. The investigation and prosecution of this case demonstrate the Department of Justice’s commitment to combating healthcare fraud and protecting the integrity of Medicare.
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