The Miami Herald: Miami-Dade couple indicted on charges of conspiring to commit home health care Medicare fraud, money laundering

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Miami-Dade couple indicted on charges of conspiring to commit health care Medicare fraud, money laundering


By Jay Weaver, The Miami Herald
9:42 PM EDT, July 27, 2011

There is life after prison — in the Medicare rackets.

Consider Luis Alejandro Sanz, who served five years for cocaine smuggling and money laundering in the 1990s. He reinvented himself by opening a Miami-Dade home health-care agency that authorities say billed Medicare more than $11 million to treat purported diabetics who, it turned out, didn't really have the disease or need nurses to inject their insulin.

Medicare paid his home care agency more than $7 million. To cover up his management role, prosecutors say, Sanz made his wife, Elizabeth Acosta Sanz, the sole corporate officer of Ideal Home Health.

On Tuesday, the 57-year-old Sanz and 44-year-old wife were indicted on charges of conspiring to commit health care fraud, money laundering and paying kickbacks to recruiters who prosecutors say supplied Medicare patients to the couple's agency between 2006 and 2009. The Sanzes are scheduled to be arraigned Friday.

Sanz's reinvention as a Medicare entrepreneur is nothing new for freed felons. The federal program claims it regularly conducts criminal background checks on Medicare operators and has disqualified felons as a result, but many have slipped through the system.

"Medicare contractors are supposed to be responsible for enrollment and screening applicants, but the process is broken and ineffective," said Ryan Stumphauzer, a former federal prosecutor who ran the health care fraud section in the Miami U.S. attorney's office and now heads his own firm.

"Felons and crooks can get as many provider numbers as they want by recruiting nominees or family members to sign documents," he said. "The nominees know absolutely nothing about Medicare, have no experience in healthcare, and couldn't pass the simplest blush test. They are never even interviewed or screened in a meaningful way."

In recent months, the taxpayer-funded Medicare program adopted new measures designed to combat the failed "pay and chase" model of doling out dollars for claims, then pursuing the schemers after they have run off with the money. As part of the new Affordable Care Act, Medicare received $350 million to develop stricter screening of healthcare providers and more sophisticated software for detecting fraudulent claims.

Among the improvements: Providers who historically have posed a higher risk of fraud, such as medical equipment suppliers and home care services, must now undergo more comprehensive screenings, including FBI criminal background checks and fingerprinting.

Also, if Medicare contractors receive a "credible" allegation of fraud from a patient, payments to a provider can temporarily be suspended while an investigation is done. New enrollment can also be temporarily halted in a healthcare area suspected of fraud.

The Sanzes' alleged Medicare scheme was deemed so serious that U.S. Magistrate Judge Patrick White denied their bids for bond Tuesday while they await trial, saying they are a risk of flight.

Assistant U.S. Attorney Dan Bernstein argued that the couple's home care agency issued Luis Sanz checks totaling $1.5 million, and another $1.5 million to DASA Investments, of which he was president. Sanz's wife received an additional $1.65 million, he said. She is being detained before trial, too.

Bernstein said the couple and their agency, Ideal, "had 40 separate bank accounts, and at the present time the government has not been able to trace all of the monies that this defendant and the co-defendant received," according to Luis Sanz's detention order.

Their attorney, Jay Moskowitz, said they were arrested by the FBI a month ago and knew the indictment was imminent. "We are dealing with the case," he said, declining to comment further.

Sanz was convicted in 1996 as part of a 20-member cocaine trafficking ring.





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