Fla. woman gets 8 years in prison for fleecing Medicare for millions at Detroit-area clinics

Fla. woman gets prison for Mich. Medicare fraud

DETROIT — A Florida woman who stole millions of dollars from Medicare while running Detroit-area clinics expanded her scheme by setting up her daughter and son-in-law with their own fraud mill.

Profits came quickly: Over one year, Daisy Martinez ripped off Medicare for $10.7 million at three clinics, and her daughter got $649,000 in just four months as they billed the government for sham drug treatments while luring desperate people off the street with cash, food and painkillers.

Martinez, 51, was sentenced Thursday to eight years in federal prison by U.S. District Judge Gerald Rosen, who said he was “just appalled” by the evidence. The case shows it’s not hard for unscrupulous people to fleece Medicare — and that’s the problem.

Settlements, fines and restitution in fraud cases added up to $4 billion nationally in the 2009 fiscal year, “just the tip of the iceberg,” Daniel Levinson, inspector general of the U.S. Department of Health and Human Services, told Congress this month.

Court records describe a seemingly simple scheme in which Martinez migrated from the Miami area to cash in on the government’s rich reimbursements for certain drug treatments given to Medicare beneficiaries. She moved to Michigan after authorities cracked down on similar scams in Florida.

In 2006-07, Martinez co-owned two clinics in suburban Detroit, Sacred Hope and X-Press Center, and had a share of another, Dearborn Medical Rehab Center. She admits lining up a doctor and dispatching recruiters to offer $50 or more to people with Medicare cards, many of them homeless, to lure them to the clinics.

The clinics regularly billed Medicare for treatments involving cosyntropin, a drug to diagnose problems with the adrenal gland. In fact, however, the treatments were not needed or never provided. Some people simply got vitamin shots.

“Her conduct resulted in hundreds of medically unnecessary infusions to HIV and hepatitis C patients for worthless services. … The purpose of these clinics was not to help sick patients but to steal money,” Justice Department prosecutors said in a court filing.

Martinez and her partner, Jose Rosario, fled to their native country, the Dominican Republic, in 2007 after authorities became suspicious of the billings and froze their bank accounts. They returned to the U.S. after being indicted last year.

Martinez and Rosario pleaded guilty to conspiracy. Nine others, including a doctor and four Medicare recipients who got kickbacks to visit clinics, also pleaded guilty in the scam or were convicted at trial.

“She was a major player in a massive series of frauds,” Justice Department lawyer John K. Neal said of Martinez.

The government has recovered $3.2 million. A “good deal” of the rest was likely hidden overseas, Neal said. Martinez’ lawyer, Juan Gonzalez of Miami, said she only got $1 million.

“I just want to apologize. … I accept my responsibility but not for the other persons,” said Martinez, speaking in Spanish.

As she spoke, jury selection began six floors below in a case against a doctor who worked at a sham clinic in Canton run by her daughter, Denisse Martinez and then-husband Jose Martinez. They have pleaded guilty to fraud and will be sentenced in April.

Like Daisy Martinez, the couple had no medical expertise. Denisse Martinez told investigators the fraud was “very obvious” because patients were driven to the clinic and there were no walk-ins, FBI agent Justin Shammot said in a court filing.

Jose Martinez said “he didn’t want to hurt or kill any patients but ultimately only wanted to make lots of money,” Shammot wrote.

The director of Medicare program integrity, Kimberly Brandt, said the new health care law will tighten rules on who can join the program, a move that should reduce the likelihood of fraud.

“Medicare was set up as a trust-based, any-willing-provider system,” Brandt said in an interview. “The goal was to allow the widest possible array of providers and suppliers into the program so senior citizens would have as wide a choice as possible. … Unfortunately, there are people who willfully take advantage of the system.”