MIAMI (CN) – Federal prosecutors say a Miami clinic defrauded Medicare of millions of dollars by filing false claims for AIDS treatments. ABC Physicians Group submitted 1,946 Medicare claims in less than a month – many of them for injections of a drug of “last resort” that’s approved only for a “very limited condition,” according to the complaint.
ABC Physicians Group was incorporated in 2004 by president Andres Hernandez and vice president Isabel Carcases. Jorge Alipio Perez-Villa became sole president and director of the clinic in March 2006; the clinic was administratively dissolved by the state in September 2006 for failing to file an annual report.
The only defendant in the complaint is the clinic – not the individuals.
While it was run by its original directors, ABC submitted 33 Medicare claims in 3 months.
But prosecutors say that in the 23 days after he took over the clinic, Perez-Villa submitted 1,946 Medicare claims, for $10.1 million. “Medicare paid defendant $2,133,664.55 for those 1,946 claims,” according to the complaint.
Many of them were for injections of Denileukin Difitox and Hylan G-F 10. Denileukin Difitox is approved by the U.S. Food and Drug Administration, but its use is limited “only for treating the very limited condition of persistent or recurrent cutaneous T-cell lymphoma (‘CTCL’) whose malignant cells express the CD25 component of the IL-2 receptor,” according to the complaint. “The drug is considered one of last resort due its ‘serious and fatal infusion reactions.’ Yet defendant claimed to have administered 1,300 doses of Denileukin Difitox in less than nine months, all for beneficiaries with AIDS, not the approved usage for treating beneficiaries with CTCL-CD25.”
Prosecutors say Perez-Villa submitted the false claims under the name of a physician who told federal agents that he never treated patients at the clinic, or in connection with the clinic, after Perez-Villa took over.
By August 2006, the Department of Health and Human Services had received at least nine complaints from Medicare beneficiaries who said they never received such injections. Prosecutors seek treble damages and civil penalties of $5,500 to $11,000 for each false claim.