Miami-Dade clinic operator pleads guilty to Medicare fraud
Recent Cases
Ihosvany Marquez spent his Medicare millions on a fleet of luxury cars, authorities say, including a Lamborghini Murcielago with spaceship-like doors that cost $455,959.
Early Monday, he pleaded guilty in Miami federal court to healthcare fraud charges alleging he submitted $55 million in false Medicare claims for HIV and cancer services at his seven Miami-Dade and Orlando clinics. Between 2005 and 2007, he and his partners raked in $22 million from the taxpayer-funded healthcare program.
Marquez, a Miami-Dade resident who could face more than 20 years in prison, ranks as a big spender among the hundreds of local Medicare-licensed operators accused of ripping off the government program for the elderly and disabled.
Among Marquez's alleged 19 car purchases for himself, his wife, other relatives and his personal trainer: A Lamborghini Gallardo, a Ferrari 612 Scaglietti, two Bentley Continental GTs, two Mercedes Benz CL63s and at least six Mercedes Benz S550s. The total tab: $2.7 million. He also spent $545,652 on jewelry and watches, among them a Rolex Meteorite for $48,000 and a diamond necklace for $108,443, authorities say. And he bought a seven-carat diamond ring for $98,086.
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.