Flor Crisologo, Healthcare Fraud, Florida 2023

Grimy Times Exclusive: Miami-area Clinic Owner Charged in $23 Million Healthcare Fraud Scheme

A Miami-area resident who owned and operated an HIV infusion clinic was arrested today and charged for her alleged participation in a $23 million HIV infusion Medicare fraud scheme, the Health and Human Services (HHS) announced.

According to the indictment, Flor Crisologo, 58, is charged with one count of conspiracy to defraud the United States, to cause the submission of false claims to the Medicare program, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims to the Medicare program.

Crisologo also is charged with one count of conspiracy to launder the proceeds of her crimes and four counts of money laundering. Crisologo made her initial appearance today in U.S. District Court in Miami before Magistrate Judge William C. Turnoff.

The indictment alleges that Crisologo was the owner and operator of J & F Community Medical Center Inc. and submitted approximately $23 million in false and fraudulent claims to the Medicare program for HIV injection and infusion services purportedly provided through J & F.

According to the indictment, Crisologo hired a physician at J & F and caused the physician to order unnecessary tests, sign false medical analyses and diagnosis forms, and authorize treatments to make it appear that medical services were being provided to patients who were Medicare beneficiaries. The services included medically unnecessary injection and infusion therapies.

The indictment alleges that Crisologo and her co-conspirators paid Medicare beneficiaries kickbacks to induce the beneficiaries to claim they received legitimate services at the clinic when in fact the HIV infusion services were either not provided or were not medically necessary.

The maximum sentence for each count of conspiracy to defraud the United States and filing false claims is five years in prison. The maximum sentence for each count of conspiracy to commit health care fraud, conspiracy to commit money laundering and money laundering is 10 years in prison.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

The case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division's Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Southern District of Miami.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 560 individuals who collectively have falsely billed the Medicare program for more than $1.2 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Source: https://www.justice.gov/archives/opa/pr/miami-area-clinic-owner-charged-23-million-health-care-fraud-scheme