A scheme to defraud the Medicare system of over $10 million through delivering fraudulent HIV services is sending a Miami doctor to prison for the next 97 months. He and five additional cohorts all pleaded guilty of conspiracy to commit healthcare fraud. The doctor was also ordered to pay more than $9 million in restitution to the Medicare program as part of the sentence handed down in U.S. District Count.

Dr. Roberto Rodriguez, 54, was the co-owner and practicing physician at Midway Medical Center Inc., in Midway, Florida. The clinic purported to specialize in the treatment of HIV patients. During his conviction trial in March, Dr. Rodriguez admitted that he and his team routinely billed Medicare for services that were medically unnecessary. In many cases, these services were never provided. In addition, his organization purchased only a small amount of drugs they claimed were administered to HIV patients at the clinic.

The manner in which the scheme worked was really quite simple and involved chemically altering blood samples before they were sent on to a lab for analysis. Most of the cases involved alleged treatments for thrombocytopenia. This is a disorder that involves a low count of platelets in the blood. According to trial plea documents, not one of the patients at the Midway Medical Center actually had a low platelet condition. Dr. Rodriguez and his co-conspirators artificially created the condition in blood samples.

Here is how the scheme worked: Before the samples were sent off to the lab for analysis, a staff chemist would manipulate them to create the appearance of the thrombocytopenia condition. Dr. Rodriguez admitted that the Center received medications designed to treat the problem knowing that the lab results were false and that the patients were not actually being treated for the condition.

In addition to this fraud at Midway, Dr. Rodriguez admitted, as the medical director for five other Miami-area HIV clinics, that he engaged in similar criminal activity between October 2003 and February 2005. The grand total of the fraud he was responsible for at all of the clinics, including Midway, totaled more the $20 million.

Four of the other defendants in the case including the chemist, another physician and two medical assistants have already been sentenced to between 37 and 90 months in prison. The sentencing of Dr. Rodriguez’s co-defendant, Dr. Carmen del Cueto, is scheduled for September. The case was investigated by the Health & Human Services Office of the Inspector General and the Federal Bureau of Investigation. Source: The U.S. Department of Justice. “Miami Physician Sentenced to 97 Months in Prison for Role in $10 Million Medicare Fraud Scheme.” June 2009. http://www.usdoj.gov/opa/pr/2009/June/09-crm-637.html