Miami HIV Infusion Clinic Director Sentenced to Prison, $17M Restitution

U.S. District Judge Cecilia M. Altonaga has sentenced Enrique Gonzalez (Gonzalez), a former Miami HIV infusion clinic director, to serve 70 months in prison for his role in a $26.2 million HIV infusion fraud scheme and ordered him to pay $17,590,896 in restitution to HHS, according to a Department of Justice (DOJ) announcement. In addition to his prison term, Gonzalez will serve three years of supervised release. On November 13, 2012, Gonzalez pleaded guilty to one count of conspiracy to defraud the United States, to cause the submission of false claims, and pay health care kickbacks and one count of conspiracy to commit health care fraud. Gonzalez admitted that during his association with Physicians Med-Care, the clinic billed the Medicare program approximately $24.5 million in HIV infusion therapy claims, for which the clinic received $16.7 million in payments. In addition, during his time with Physicians Health, the clinic billed Medicare approximately $1.7 million. He received approximately $800,000 in payment from the Medicare program for fraudulent services.

The Scheme

According to the DOJ, Gonzalez admitted that between August 2002 and March 2004, he conspired with co-defendant Ronald Harris (Harris), a Miami physician, to operate Physicians Med-Care and Physicians Health, two Miami HIV infusion clinics (physicians clinics), which were owned and controlled by alleged co-conspirators Carlos Benitez and his brother Luis Benitez. Although the physician clinics claimed to specialize in treating patients with HIV, according to the court documents, the sole purpose of their operation was to committing Medicare fraud. Gonzalez, who was a director of Physicians Med-Care, also admitted that he agreed with his co-conspirators to handle the finances for the physician’s clinics by moving the money paid by the Medicare program out of the physician clinics’ accounts and into accounts owned and controlled by his co-conspirators, the DOJ said. Under the direction of his co-conspirators, Harris signed blank checks that Gonzalez used to transfer funds to various Benitez-owned entities and others. In addition, Gonzalez agreed to provide cash to various co-conspirators at the physician clinics to be used to pay bribes and kickbacks to the Medicare beneficiaries in return for those beneficiaries allowing the physician clinics to bill the Medicare program for HIV infusion services that were not medically necessary and often not provided, the DOJ reported.

Other Conspirators’ Charges

In connection with his role as medical director for the Physicians clinics, Harris pleaded guilty on August 26, 2008, to one count of conspiracy to defraud the United States, to cause the submission of false claims 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. He was sentenced to serve 84 months in prison for his role in the scheme, DOJ said. Carlos and Luis Benitez and Thomas McKenzie were charged separately with health care fraud and money laundering crimes for committing approximately $109 million in HIV infusion fraud and money laundering through the physician clinics and nine other HIV infusion clinics in an indictment unsealed on June 11, 2008. Court records show that they provided the money and staff necessary to open the physicians clinics, the Medicare patients that the clinics needed to bill the Medicare program, and transportation for the HIV patients who visited the clinics. McKenzie pled guilty to one count of conspiracy to commit health care fraud and one count of submitting false claims to the Medicare program, and admitted to his role in a $119 million HIV infusion fraud scheme. He was sentenced to serve 14 years in prison. Carlos and Luis Benitez are fugitives.