Federal watchdogs have tied a bow on a key part of one of the largest Medicare fraud schemes in history.
The U.S. Attorney’s Office for the Southern District of Florida announced Friday that Rodolfo Pichardo and Marta Pichardo — husband and wife — were each sentenced to several years in prison for their roles building “a vast empire of fraud” from May 2010 through September 2016. The couple’s empire included at least six fraudulent home health agencies, three fraudulent therapy staffing companies and two fraudulent pharmacies.
Over the years, the Pichardos and their co-conspirators used their phony network — located throughout Florida’s Miami-Dade County — to submit more than $38 million in false and fraudulent claims, according to Department of Justice officials. Medicare ultimately paid out more than $33 million of that.
With millions from Medicare, the Pichardos went on to purchase multiple properties, high-end vehicles, expensive jewelry, plane tickets, vacations, cosmetic procedures and more, both for themselves and family members, court documents state.
That lavish lifestyle is a stark contrast to the husband and wife’s humble beginnings in the United States. The Pichardos came to the U.S. from Cuba, arriving on a raft “seeking refuge and a better life.”
Quality Care Home Health Agency, Rapid Home Health Services and Tender Home Health Services were just some of the business names reportedly in the Pichardos’ fraud scheme. Other company names included Alegre’s Home Health Care, B&M Home Health Care, Apple Health Care Services, RP Staffing Inc. and more.
Contextually, the Pichardos’ empire of fraud was tied to a bigger takedown involving $1 billion in fraud.
Philip Esformes — the owner of more than 30 Miami-area skilled nursing and assisted living facilities — was the mastermind of that bigger case, unveiled in July 2016.
“This case involves the largest fraud scheme in terms of loss amount ever charged in the history of the Medicare fraud strike force,” U.S. attorney Wilfredo A. Ferrer said at a press conference at the time. “The case allegedly involved an elaborate cycle and network of bribery, deceit and kickbacks that compromised Medicare care services for thousands of [Medicare and Medicaid beneficiaries] at south Florida hospitals, skilled nursing and assisted living facilities.”
Rodolfo Pichardo, 71, was sentenced to more than 15 years in prison for health care fraud and wire fraud scheme. Marta Pichardo, 66, was sentenced to eight years in prison for her role in the scheme.
As part of the Pichardos’ scheme, the couple offered and paid kickbacks to numerous patient recruiters in exchange for referrals to home health agencies that he owned. The conspirators also offered and paid cash kickbacks to owners and operators of multiple Miami-Dade medical clinics in return for acquiring medically unnecessary home health prescriptions for the recruited Medicare beneficiaries.
Prescriptions were then used by the Pichardos’ various home health agencies and pharmacies to bill Medicare for purported services and pharmaceutical drugs that were provided to allegedly qualified Medicare beneficiaries.
During the long-running scheme, the Pichardos took several “calculated steps” to conceal the fraud and avoid detection, according to DOJ officials. That included using nominee owners, changing names and locations of their fraudulent entities, and creating shell companies to hide assets.
“These schemes … are incredibly complex,” Ferrer said. “They’re elaborate. And their incredibly difficult to detect.”
In fiscal year 2018, federal watchdog investigations resulted in criminal actions against 764 individuals or entities and civil actions against 813. The Department of Health and Human Services Office of Inspector General (OIG) recovered $2.91 billion last year.