Florida Drug Ring Used Patients for Prescription Painkillers, Charged with Medicare Fraud
Four suspects, including one with a history of drug dealing, have been arrested on charges of Medicare fraud for using HIV patients as a source of prescription drugs sold on the black market.
Brian Francis Kelly, 53, Gladys Fuertes, 40, Mario Fuertes, 38, and Cathleen Ortega, 55, were all arrested on charges of Medicare fraud, conspiracy, and kickback charges in Florida.
Kelly and his cohorts reportedly referred HIV patients from the Coral Gables clinic, where they filed claims for prescription painkillers and medical care through Medicare part D, as well as the now-defunct insurance company, Universal Healthcare Group, which filed for bankruptcy in 2013.
Reportedly, the insurer went bankrupt amid charges of fraud and embezzlement, which the federal government now believes were related to the prescription painkiller drug ring.
As part of a plea agreement, Kelly signed a document stating that he recruited patients for the Fuertes couple’s clinic, Gables Medical and Therapy Center. The clinic then used patient identities to file Medicare claims for medical services not provided. The Fuertes’ clinic then paid patients kickbacks for prescription painkillers like oxycodone, although some patients took the medication, which sometimes was prescribed with forged prescription notes.
“Some patients took the oxycodone pills prescribed, while others sold the pills to Kelly for cash,” the document states. “Kelly sold the oxycodone pills to street-level users and other distributors in Florida and Pennsylvania in exchange for cash, typically between $25 to $50 per pill.”
The prescriptions for the opioid painkillers were reportedly filled at a pharmacy in Ft. Lauderdale, which also filed for reimbursement under Medicare Part D.
The Gables Medical and Therapy Center filed for $1 million in false claims, which Universal Insurance paid $266,423. In one extreme case, the clinic billed $91,342 for a patient who received no treatment.
The Fuerteses have officially been charged with conspiracy, health care fraud, aggravated identity theft, and obstructing a health care investigation. Ortega pleaded guilty to making false statements.
Kelly, meanwhile, has been convicted on charges of possession of methamphetamines with intent to distribute, so he has a history of drug crimes in Florida already. It is currently unclear what sentence he will receive as part of his Medicare fraud plea agreement.
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