2 Sisters Wanted In $9.1-Million Medicare Fraud Case Arrested In South America

March 16–Two sisters wanted in a $9.1-millionMedicare fraud investigation into their Dearborn clinic have been arrested in South America and will be returned to Detroit to face charges, the nation’s highest health official announced Tuesday at a Medicare fraud conference in Detroit.

Clara Guilarte , 56, and Caridad Guilarte , 54, missing since February 2007, were on a federal most-wanted list for Medicare fraud. They were apprehended Sunday as they tried to get on a plane in Colombia, said Kathleen Sebelius , secretary of the U.S. Department of Health and Human Services.

Tom Spokaeski , an investigator with the federal fraud task force in Detroit, said the sisters were arrested after tipsters called a national Medicare fraud hotline.

They are charged with committing fraud at the Dearborn Medical and Rehabilitation Center, a drug infusion clinic they opened that served people with AIDS and HIV, hepatitis C and other chronic conditions.

Sebelius also announced the creation of a $165,000 TV and radio campaign on Medicare fraud to run in 18 cities, including Detroit, where fraud has been rampant.

Federal authorities came Tuesday to Detroit — a national target of Medicare fraud scams — to announce a new TV and radio ad campaign and to tout heightened law enforcement efforts starting this month to stop schemes early on.

“We’d like to stay one step ahead of them instead of waiting to see what they are doing,” said Kathleen Sebelius , secretary of the U.S. Department of Health and Human Services, which oversees the nation’s Medicare and Medicaid insurance programs.

Detroit, one of nine cities where a federal task force is trying to reduce Medicare fraud, is considered a target for the scams because it has a large population of elderly, poor and chronically ill homeless men. Some of the scam artists moved to the city from Miami, after a major federal crackdown there.

The scams generally have involved recruiters giving Medicare recipients cash in exchange for their Medicare information, which is then used in fraudulent billings.

Such a scam was at the heart of a Dearborn case in which federal authorities arrested two sisters Sunday in Colombia.

Clara and Caridad Guilarte , who had been involved in questionable clinic activities in Miami, came to Detroit in 2005 to flee the heightened federal scrutiny there, federal court records show.

They filled out a simple form to establish a Michigan corporation — paperwork that essentially requires little beyond the name of the registered agent for the company — found a doctor who was certified to bill Medicare and opened the Dearborn Medical and Rehabilitation Center.

Like the ones the sisters were associated with in Miami, the Dearborn facility was a drug infusion clinic for people with AIDS, hepatitis C and other health conditions. They are charged with $9.1 million in fraudulent Medicare billings.

The sisters were expected to be arraigned in Miami on Tuesday, before being returned to Detroit.

At the conference at Wayne State University, federal officials said they will expand fraud enforcement with new tools that take effect March 25.

They include computer programs that red-flag questionable billings; shared information among states to stop those convicted of fraud from moving to another state and opening up business, and suspension of payments when there are credible fraud charges.

The Department of Health and Human Services also will award $380,000 in grants to allow Michigan and 50 other state or local programs to expand Senior Medicare Patrols, which educate seniors about spotting fraud.

Seniors never should let anyone use or borrow their Medicare information, and they should review Medicare statements to be sure a provider has not billed for care not received, federal authorities say.

To report questionable billings, call 800-633-4227; to report fraud, call 800-447-8477.

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