February 26, 2021
Two women pleaded guilty today in connection with a multi-million dollar Medicare fraud scheme.
Talia Alexandre, 30, of Palm Springs, Fla., pleaded guilty to one count of receiving kickbacks in connection with a federal health care program. Stefanie Hirsch, 51, of Los Angeles, Calif., pleaded guilty to violating the HIPAA statute.
According to charging documents, co-conspirator Nathan LaParl and Alexandre sold Medicare patients’ personal and medical data to Juan Camilo Perez Buitrago. Alexandre and LaParl worked with foreign call centers to contact Medicare patients to ask if they were interested in durable medical equipment (DME) such as arm, back, knee and shoulder braces “at little to no cost.” The call centers collected demographic and insurance information from Medicare patients, which Alexandre and LaParl sold to Perez Buitrago. Alexandre received more than $1.4 million from Perez Buitrago for the patient data. Perez Buitrago used that patient data to submit more than $109 million in false and fraudulent claims, submitting claims for DME that was not prescribed, not necessary, and, in many instances, never requested or received.
To perpetuate the scheme, Perez Buitrago and LaParl checked Medicare patients’ insurance eligibility by improperly accessing a patient eligibility tool provided by Hirsch. Hirsch owned EI Medical, Inc., a Medicare-enrolled wheelchair and scooter repair company that qualified for access to a health care clearinghouse that contains Medicare patients’ personal, medical and insurance information. Hirsch improperly gave LaParl and Perez Buitrago access to that clearinghouse and charged them about $0.25 per patient eligibility check. Using Hirsch’s credentials, LaParl accessed the personal and medical data of more than 350,000 patients and Perez Buitrago’s credentials were used for 150,000 patients.
Read the full press release.
If you know anyone receiving calls regarding Durable Medical Equipment such as braces, please have them contact Ohio SMP at 1-800-488-6070 option 7, use the “Report Fraud” button on this App, or click here.
Source: Department of Justice