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Modesto de la Vega, 59, and Wife Plead Guilty to HIV Infusion Clinic Fraud
A Miami-area husband and wife, Modesto de la Vega and Victoria de la Vega, have pleaded guilty to participating in a $13.7 million HIV infusion Medicare fraud scheme. The scheme, which took place from January 2003 to July 2005, involved enlisting patient recruiters and patients into a scheme to defraud Medicare.
According to plea documents, Modesto de la Vega, an owner and operator of T&R Rehabilitation Professional Corp., a Miami clinic, admitted to agreeing with his co-defendants to pay kickbacks and bribes to patients so that T&R could bill the Medicare program for HIV infusion services that were not medically necessary and/or were not provided.
The defendants admitted to causing T&R to submit fraudulent claims to the Medicare program in the amount of approximately $13.7 million, with Medicare paying approximately $4.1 million of these fraudulent claims.
Modesto and Victoria de la Vega pleaded guilty to one count of conspiracy to defraud the United States, to cause submission of false claims to Medicare, and to pay health care kickbacks; one count of conspiracy to commit health care fraud; and three counts of submitting false claims. They face a maximum penalty of five years in prison for the conspiracy to defraud the United States count and each false claims count, and 10 years in prison for the health care fraud conspiracy count.
The couple’s sentencing is scheduled for November 5, 2010, and they are currently being held without bail.
In a separate case, two Miami-area residents, Keith Earnest Humes and Lawrence Edward Humes, were sentenced to 84 months and 33 months in prison, respectively, for their participation in a similar HIV infusion Medicare fraud scheme. Keith Humes was ordered to pay restitution in the amount of $539,485, while Lawrence Humes was ordered to pay $222,967.
According to court documents, Keith and Lawrence Humes conspired with other individuals to defraud Medicare by submitting false claims for injection and infusion treatments that were medically unnecessary and that in most instances were not provided. They paid kickbacks to beneficiaries in return for their Medicare numbers and signatures, which their clinic, Tendercare Medical Center Inc., used to submit the false claims.
The two Humes men were sentenced to prison for their participation in the scheme, which resulted in approximately $5.8 million in false and fraudulent claims being submitted to Medicare, with Medicare paying approximately $2.7 million.
Key Facts
- State: Federal
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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