Sunday, August 26, 2012

Odalys Fernandez and Kelvin Soto Were Convicted of Conspiracy to Commit Health Care Fraud and Health Care Fraud


Wifredo Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher Dennis, Special Agent in Charge, U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG), announce that a federal jury in Miami found Odalys Fernandez, of Miami, Florida, and Kelvin Soto, of Hialeah, Florida, guilty of conspiracy to commit health care fraud and health care fraud charges following a one week trial before U.S. District Judge Ursula Ungaro.

The jury convicted Fernandez and Soto each of one count of conspiracy to commit health care fraud in violation of Title 18, United States Code, Section 1349; five counts of health care fraud for Fernandez; and four counts of health care fraud for Soto, in violation of Title 18, United States Code, Section 1347.

According to the evidence presented at trial, Soto and Fernandez were registered nurses (RN) employed by Ideal Home Health, a company that submitted approximately $40 million in false claims to Medicare. As part of their jobs as RNs, Soto and Fernandez purportedly provided skilled nursing services to homebound insulin dependent diabetics who were so ill that they were unable to inject themselves with insulin. Under Medicare regulations, Soto and Fernandez were required to keep records of each and every time they provided a skilled nursing service to a Medicare beneficiary. Between August 17, 2007 and March 19, 2009, the defendants completed hundreds of documents in which they claimed that they had injected Medicare beneficiaries with insulin two times a day, seven days per week. At trial, the evidence showed that at least three of the Medicare beneficiaries that the defendants claimed to be injecting with insulin were not even diabetic. Evidence was also presented showing that beneficiaries were paid $1,000 cash kickbacks in return for agreeing to pretend to need the skilled nursing services. In addition, there was evidence presented that defendant Soto claimed to be providing injections to two and three Medicare beneficiaries at the same time. Based upon the defendants’ false statements, hundreds of thousands of dollars in claims were submitted to Medicare for services that were not medically necessary or actually provided to Medicare beneficiaries.

Sentencing in this case has been set for November 9, 2012. The defendants are facing a statutory maximum of 10 years’ imprisonment as to each count.

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