Jose Morales Commits $23 Million Health Care Fraud

Jose Carlos Morales co-owner of Pharmovisa, Inc. and PharmovisaMD Inc., pleaded guilty to to paying kickbacks and submitting fraudulent claims for pharmaceuticals to Medicare and Medicaid. According to the Department of Justice, Morales and his co-conspirators submitted false and fraudulent claims to the government agencies, which amounted to approximately $23,367,775.

Morales pleaded guilty to agreeing to pay illegal health care kickbacks to co-conspirators in return for a stream of beneficiary information to be used to submit claims to Medicare and Medicaid. The beneficiaries who were referred to Pharmovisa and PharmovisaMD (Morales pharmacies) in exchange for kickbacks payments resided at assisted living facilities (ALFs) located in Miami. Morales and his alleged co-conspirators also paid illegal health care kickbacks to physicians in exchange for prescription referrals, which the Morales pharmacies ultimately billed to Medicare.

In 2007 drivers working for Morales pharmacies delivered “bingo cards” containing pop out medications to ALFs located throughout the Southern District of Florida. Morales instructed these drivers to pick up any unused “bingo cards” so that Morales pharmacy personnel could place these medications back into pill bottles. Unused and partially used medications were eventually re-billed to Medicare and Medicaid, and a majority of the previously submitted claims to Medicare and Medicaid were never reversed. Morales also instructed Morales pharmacy personnel to place unused and partially used medications into bottles to be sold directly to the general public from the “community” pharmacy shelves.

On Oct. 16, 2012, Esperanza Navailles, a former “marketer” for the Morales pharmacies, pleaded guilty to conspiracy to defraud the United States and pay illegal health care kickbacks. From February 2011 to January 2012, Navailles, on behalf of the Morales pharmacies, paid ALF owners and operators $30 per patient per month for each Medicare beneficiary they referred to the pharmacies. The Morales pharmacies then submitted claims to Medicare for items and services on behalf of the referred Medicare beneficiaries. Navailles admitted that she knew the kickback payments were illegal.