Second guilty plea in $28M Medicare scam

A second former Southwest Florida resident admitted to his role in a $28.3 million Medicare fraud scheme that involved multiple outpatient rehab facilities in Florida, including one in Venice and one in Fort Myers.

Luis Duluc, 53, pleaded guilty to conspiracy to commit health care fraud and making a false statement relating to health care matters, according a release from the U.S. Attorney's office. Margarita M. Grishkoff, 59, of Charlotte, N.C., and formerly of Southwest Florida, previously pleaded guilty to conspiracy to commit health care fraud in the case. The FBI and the U.S. Health and Human Services Office of the Inspector General brought the case against Grishkoff and Duluc through the Medicare Fraud Strike Force. The U.S. Attorney's office for the Middle District of Florida, based in Tampa, oversaw the investigation.

Authorities contend Grishkoff and Duluc used various physical therapy clinics and other business entities throughout Florida and other states to submit fraudulent reimbursement claims to Medicare from 2005 through 2009. Those claims, according to prosecutors, totaled $28.3 million, and Medicare paid approximately $14.4 million on those requests. 

Duluc, authorities say, was chairman and president of a Delaware based-Ulysses Acquisitions Inc., which he and other conspirators used to purchase comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers. Those included West Coast Rehab Inc. in Fort Myers and Rehab Dynamics Inc. in Venice, among other locations. The goal of the purchases, according to prosecutors, was to gain control of the clinics' Medicare provider numbers. 

Duluc and his co-conspirators also obtained unique identifying information of physicians, prosecutors say. “They then used this information to create and submit false claims to Medicare through the clinics Ulysses Acquisitions purchased,” the release states. “These claims sought reimbursement for therapy services that were not legitimately prescribed and not actually provided. The conspirators created and used false and forged patient records in an effort to conceal the fact that services had not actually been provided.”
 
Part of the conspiracy, prosecutors say, included what came to be known as the 80/20 deal, which Duluc developed and marketed. The 80/20 deal involved extensive kickback arrangements with co-conspirators who owned other therapy clinics that were used to further the overall fraud scheme. 

A sentencing date hasn't been set yet for Duluc. He faces a maximum penalty of 15 years in prison.