12-20113-CR-COOKE/TURNOFF

Case 1:12-cr-20113-MGC Document 1 Entered on FLSD Docket 02/21/2012 Page 1 of 10 TB Feb 21, 2012

U NITED STA TES D ISTR IC T C O UR T SO U TH ERN D ISTR IC T O F FLO R ID A

12-20113-CR-COOKE/TURNOFF C ase No.

18U.S.C.1371 18U.S.C.5 982 U NITED STAT ES O F A M ER ICA VS.

GRICEL FONT and ISA UR A BO U -M EL EN D EZ, D efendants. / IN FO RM A TIO N

TheUnited StatesAttorney chargesthat: G EN ER AL A LLE GA T IO N S

Ata11tim esrelevantto thisInform ation: The M edicare Proaram

1.

TheM edicareProgram ('dM edicare'')wasafederallyfundedprogram thatprovided

free or below-costhealth care benefts to certain individuals,prim arily the elderly,blind,and disabled. The benefits available under M edicare were governed by federal statutes and

regulations.TheUnited StatesDepartmentofHealth and Human Services($'HHS''),through its agency,the Centers forM edicare and M edicaid Services ($$CM S''),oversaw and administered M edicare. lndividuals who received benefits under M edicare were com monly referred to as M edicare 'beneficiaries.''

M edicarewasa$'hea1th cm' e benefk progrnm ,''asdefined by Title 18,United States

Code,Section 24(b).

Case 1:12-cr-20113-MGC Document 1 Entered on FLSD Docket 02/21/2012 Page 2 of 10

3.

PartA ofthe M edicare Program wasam edicalinsurance program thatcovered,

am ong otherthings,certain physician and outpatientservicesthatwere m edically necessary and ordered by licensed m edicaldoctors or other qualified health care providers. PartA ofthe M edicare Program also covered certain outpatient services, including physical therapy,

rehabilitation and occupationaltherapy (''PT/OT' ')services,which weretypically administered atComprehensive OutpatientRehabilitation Facilities (1dCORFs'')or by Outpatient Physical

Therapy Providers('OPTs''). M edicare PartA covered such services so long as they were ordered by a medicaldoctor or other qualified health care provider,and deemed medically necessary.

M edicare Billinz and Pavm entProcedures

4.

A CORF orOPT thatsoughtto participate in M edicare PartA and billM edicare

forthe costofPT/OT serviceswasrequired to apply forand receive a I'supplier number'for PartA ofthe M edicare Program .

For Florida M edicare beneficiaries, M edicare Part A PT/OT benefhs were

administered byFirstCoastServiceOptions('dFirstCoast''),pursuanttoacontractwithHHSto

receive,process and pay claims.First Coastreceived,adjudicated and paid the claims of authofized PT/OT providers thatwere seeking reim bursement for the cost of PT/OT services

supplied orprovided to M edicarebenefciaries. To receive paymentfrom M edicare,a CORF or OPT,using its PartA supplier number, would submit a health insurance claim form known as a CM S-1450. M edicare perm itted CORF and OPT com paniesto subm it CM S-1450's electronically orby way of a paper

claim form. Each claim form required certain information, including: (a) the Medicare beneiiciary'snnmeandidentificationnumber;(b)theidentificationnumberofthedoctororother 2


qualitied health care providerwho ordered orfurnished the health care benefk, item ,orservice

thatwasthesubjectoftheclaim;(c)thehealthcarebenetk,item,orservicethatwasprovided or suppliedtothebeneticiary;(d)thebillingcodesforthebeneft,item,orservice;and (e)thedate upon which thebenefit,item ,orservicewasprovided orsuppliedto thebeneficiary. M edicare,through FirstCoast,would generally pay a substantialportion ofthe costof the related health care beneûts,item s,and servicesthatwere m edically necessary and

ordered by licensed doqtorsorotherqualifiedhealth careproviders. PaymentsunderM edicare PartA were often m ade directly to the CORF or OPT company ratherthan to the patient/beneficiary. Forthisto occur,the beneficiary would assign therightofpaymentto the COR.F orOPT company orotherhealth careproviders. Once such an assignm ent took place, the CORF or OPT com pany would assum e the responsibility for subm itting claim sto,and receiving paym entsfrom ,M edicare. Font & B ou A ssociatesR ehab.Inc.

Font& Bou Associates Rehab,lnc.(hereinafterEtFont& Bou'')wasa Florida corporation incorporated on Decem btr 7, 2004, that was located in M iami-Dade County, purportedly providing PT/OT servicesto M edicarebeneficiaries. 10.

Font& Bou'sprincipalplace ofbusinesswaslocated at14100 Palmetto Frontage

Road,#380,M iam iLakes,Florida. The Defendants

11.

DefendantGRICEL FONT was a residentofBroward County,in the Southern

D istrictofFlorida. FO N T w aspresidentand registered agentof Font& Bou

DefendantISAUR A BO U-M ELENDEZ was a resident ofBroward County, in the Southern D istrictofFlorida.BO U -M ELEN D EZ w asvice-presidentofFont& Bou.


CONSPIR ACY TO COM M IT H EALT H C AR E FM U D -

(18U.S.C.5371) 13.

Btginning on or about January 2,2006, and continuing tllrough on or about

February 25,2010,in M iam i-Dade County,in the Southern DistrictofFlorida, and elsewhere, thedefendants,

GW CEL FONT and ISAUR A BOU M ELENDEZ,

did willfully,thatis,with the intentto further the objectofthe conspiracy,and knowingly combine,conspire,confederateand agreewith each otherand othersknown and unknown to the United StatesAttorney,to violateTitle 18,United StatesCode,Section 1347, thatis,to execute a

schem e and artifice to defraud M edicare,a health care benetitprogram affecting comm erce, as

defined in Title 18,United StatesCode,Section 24(b),and to obtain,by meansofmaterially false and fraudulentpretenses,representations,and promises,m oney and property owned by, and underthe custody and controlofM edicare,in connection with the delivery ofand paymentfor health care benefits,item s,and services. PURPO SE O F THE CO NSPIRACY

14.

Itwas the purpose ofthe conspiracy forthe defendants and theirco-conspirators

to unlawfully enrich themselves by, among other things: (a) submitting or causing the submission offalse and fraudulentclaimsto Medicare;(b)concealing the submission offalse and fraudulentclaims to M edicare and the receipt and transfer of fraud proceeds;and (c) diverting fraud proceedsforthepersonaluse and benefh ofthem selvesand others.

4


M AN N ER AN D M EAN S O F TH E CO N SPIM CY

The m anner and means by which the defendants and their co-conspirators sought to

accomplish the object and purpose of the conspiracy included, among other things, the following: 15.

GRICEL FONT and ISAUR A BOU-M ELENDEZ owned and controlled Font

& Bou.

Beginning on or about January 2,2006,and continuing tlzrough on or about February 25,2010,G RICEL FO NT,ISAUR A BOU-M ELENDEZ,and theirco-conspirators

submitted and caused Font& Bou to subm itapproxim ately $6,908,986 in M edicare claim s for P' T/oT-related reim bursement,which claims falstly and fraudulently represented that PT/OT item sand serviceswereprescribed by adoctorand provided to M edicare benetk iaries. Asaresultofsuch falseand fraudulentclaims,M edicare deposited approximately

$4,944,057 into Font& Bou'scorporate accounts. 18.

GRICEL FO NT,ISAURA BOU-M ELENDEZ and their co-conspirators used

theproceedsofthehealth care fraud fortheirpersonalbenefitandto furtherthefraud. O V ER T A C TS

ln furtheranceoftheconspiracy,andtoaccomplish itspurposeandobject,atleastoneof the co-conspiratorscomm itted,orcauseto be com mitted,in the Southern DistrictofFlorida, and elsewhere,atleastoneofthefollowing overtacts,among others: On or about Septem ber 25, 2009, GRICEL FONT and ISAURA BO UM ELEN D EZ,through Font& Bou,subm itted a claim on behalfofM edicare beneficiary I.C.for

PT/OT services,when in factno PT/OT serviceswereprovided to I.C.by Font& Bou.


On or about October 9, 2009, GRICEL FONT and ISAUM

BOU-

M ELENDEZ.through Font& Bou,subm itted a claim on behalfofM edicr e beneticiary B .V . forPT/OT services,when in factno PT/OT serviceswereprovided to B.V.by Font& Bou. On or about October 16, 2009, G RICEL FONT and ISAURA BO UM ELENDEZ,through Font& Bou,subm itted a claim on behalfof M edicare benesciary T.R . forPT/OT services,when in factno PT/OT serviceswereprovided to T.R.by Font& Bou.

Allin violation ofTitle 18,United StatesCode,Section 371. FO R FEITU RE

(18U.S.C.j982) The allegations contained in this Inform ation are realleged and incorporated by reference as though fully set forth herein for the purpose of alleging forfeiture to the United States ofAm erica ofcertain property in which the defendants,GRICEL FONT and ISAUR A BO U -M ELEN D EZ,have an interest.

2.

Upon conviction of the violation as alleged in this Inform ation,the defendants

shallforfeit al1of their right,title and interest to the United States of any property,realor

personal,thatconstitutesorisderived,directly orindirectly,from grossproceedstraceableto the

commissionofsuchviolation,pursuanttoTitle18,UnitedStatesCode,Section 982(a)(7).

3.

The property subjectto forfeiture includes,but is notlimited to,the sum of

$4,944,057 in United Statescurrency,which sum is equalto the grossproceedstraceableto the comm ission ofthe violation alleged in this lnform ation,which the United Stateswillseek as a

forfeituremoneyjudgmentaspartofthedefendant'ssentence.

6


A1lpursuanttoTitle 18,United StatesCode,Section 982(a)(7);andtheproceduresset forth atTitle 21,United States Code,Section 853,as made applicable through Title 18,United

StatesCode,Section 982(b)(1).

h

W lF O A .FER RER UNITED STATES ATTORNEY

JO .JU E G ER A S STAN U N ITED STATES A TTO RN EY