Medicare Compliance & Reimbursement

Investigators find millions of dollars worth of improper Medicare payments.

Miami appears to be ground zero for health care fraud prosecutions right now. A jury found physician Frantz Achille guilty of conspiracy and health care fraud. Achille was a physician at two Miami HIV/AIDS clinics and allegedly forged medical paperwork to receive $2.1 million from Medicare. Patients either never needed the expensive treatments or never received them. The clinic paid patients a kickback to show up, prosecutors said.

Meanwhile, Miami physician Julian Torres was arrested Jan. 30 and charged with conspiracy and other federal crimes. The owners of Carob Medical Services allegedly paid $20,000 in kickbacks to Torres to prescribe medical equipment for patients who didn't need it. Carob received around $1 million from Medicare for this equipment.

Finally, Diana Sotto, owner of All Medical Billing Systems, was sentenced to 10 years' imprisonment, followed by three years' supervised release. She helped Miami clinic Project New Hope to defraud Medicare of more than $2.8 million from Sept. 2004 to Sept. 2005, billing for HIV/AIDS medications for patients who actually were HIV-positive but didn't receive the medication.