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Troy Couple Plead Guilty In $13.4M Medicare Fraud

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CBS Detroit (con't)

Affordable Care Act Updates: CBSDetroit.com/ACA

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TROY (WWJ/AP) - Federal prosecutors say a Troy couple who ran clinics that claimed to specialize in treating HIV have pleaded guilty to participating in a multimillion-dollar Medicare fraud scheme.

The U.S. attorney’s office in Detroit said 40-year-old Raymond Arias and his wife, 25-year-old Emelitza Arias, made the pleas Wednesday before U.S. District Judge Paul Borman.

The Arias face sentencing Feb. 12, 2013, for conspiracy to commit health care fraud. The charges carry a maximum penalty of 10 years in prison and a $250,000 fine.

Raymond Arias conceived of and oversaw fraud schemes at two clinics he owned: Elite Wellness LLC, and Carefirst Occupational & Rehabilitation Center Inc.

According to a press release from the U.S. Attorney’s Office, Raymond Arias admitted to paying physicians to refer patients with Medicare benefits to Elite Wellness, and to purchasing Medicare beneficiary identifications for the purpose of submitting fraudulent claims to Medicare for expensive infusion therapy services that were not rendered as claimed by Carefirst.

Court documents show that Emelitza Arias participated with her husband in the scheme to defraud Medicare by submitting claims for expensive infusion therapy services that were not rendered by Carefirst, of which she was also an owner. In an attempt to create an appearance that Carefirst was a legitimate business, Emelitza Arias allegedly injected patients with vitamins.

The government says the couple submitted about $13.4 million in bogus claims in 2009-2011, and Medicare paid about $5.9 million — $2.6 million of which Raymond Arias had wired to offshore bank accounts in Panama and Mexico.

TM and © Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2012 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed. The Associated Press contributed to this report.

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