Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 1 of 14

UN ITED STA TES D ISTRIC T C O U RT

SOUTHERN
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C ase No. .

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18U.S.C.5 1349
18U.S.C.5 1347
18U.S.C.1 2
18U.S.C.5 982(a)(7)
UN ITED STA TE S O F A M ER ICA

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CA R LO S J.GA R CIA ,
G ISELL A BEM STU R IA ,and
H EIDY G A RC IA ,

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D efendants.

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IN DIC TM EN T
The Grand Jury charges that:
G EN ER AL A LLEG A TIO N S

Atal1timesmaterialto thislndictment:
The M edicare Proeram

TheMedicareProgram (Medicare)wasafederally fundedprogram thatprovided
free or below -cost health care benefits to certain individuals,prim arily the elderly,blind, and
disabled.The benefitsavailable underM edicare w ere govem ed by federalstatutesand regulations.
The United States D epartm entof Hea1th and Hum an Services,through its agency,the Centers for

M edicareand M edicaid Selwices(CM S),oversaw and administered M edicare.lndividualswho
received benefits underM edicare w ere com m only referred to as M edicare Idbeneticiaries.''
M edicare program s covering differenttypes ofbenefits w ere separated into different

program d'parts.''PartD ofMedicare (the ttMedicare PartD Program'')subsidized the costs of

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 2 of 14

prescription drugsforM edicarebeneficiariesin the United States.TheM edicare Pal4 D Program
w as enacted as partof the M edicare Prescription Drug,lm provem ent,and M odernization A ct of
2003 and w entinto effecton January 1,2006.

ln order to receive Pa14 D benefits,a beneficiary enrolled in a M edicare dnlg plan.

M edicarednzgplanswereoperatedbyprivatecompaniesapproved by M edicare.Thosecompanies
w ere often referred to as dnlg plan tlsponsors.''A beneficiary in a M edicare drug plan could filla
prescription ata pharm acy and use his orherplan to pay for som e ora11ofthe prescription.
4.

A pharm acy could participate in Part D by entering a retail netw ork agreem ent

directlywithaplanorwithoneormorePharmacyBenefitM anagers('dPBM s''). A PBM actedon
behalfofoneormoreMedicaredrugplans.Throughaplan'sPBM ,apharmacycouldjointheplan's
network. W hen a Part D beneficiary presented a prescription to a phanuacy, the pharm acy

subm itted aclaim eitherdirectly to theplan orto a PBM thatrepresented the beneficiary'sM edicare
drug plan.The plan or PBM determ ined whetherthe phannacy w as entitled to paym entfor each

claim and periodically paid the pharm acy for outstanding claim s. The drug plan's sponsor
reim bursed the PBM foritspaym entsto the pharm acy.
A pharm acy could also subm itclaim sto a M edicare drug plan to w hosenetw ork the

pharm acy did notbelong.Submission ofsuch out-of-network claim swasnotcom mon and often
resulted in sm allerpaym entsto the pharm acy by the drug plan sponsor.

6.

M edicare,through CM S,compensated theM edicarednlgplan sponsors. M edicare

paid the sponsors a m onthly fee for each M edicare benetk iary of the sponsors' plans. Such

paymentswerecalledcapitationfees.Thecapitationfeewasadjustedperiodicallybasedonvarious
factors,including the beneticiary'sm edicalconditions.ln addition,in som e casesw here a sponsor's
2

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 3 of 14

expensesforabeneficiary'sprescription dnlgsexceededthatbeneficiary'scapitation fee,M edicare
reim bursed the sponsorfora portion ofthose additionalexpenses.

Medicareand Medicare drugplan sponsorswered'health carebenefitprogramgsj,''

asdefinedbyTitle18,UnitedStatesCode,Section24(b).
The D efendants and Related C om panies

8.

CapitalDrttgs,Inc.(CapitalDnlgs)wasaFloridacorporation located at1065SW

27th Avenue,M iam i,Florida,thatdid business in M iam i-Dade County pup ortedly providing
prescription drugsto M edicare beneficiaries.

GreenHopePhannacy,lnc.(GreenHope)wasaFloridacorporationlocatedat5309
SW 8th Street,M iam i,Florida,thatdid business in M iam i-Dade County purportedly providing
prescription drugsto M edicare beneticiaries.

10. American Drugs Phannacy,lnc.(American Drugs) was a Florida corporation
located at 2111 10th A venue,Lake W orth,Florida,thatdid business in the Southem D istrid of
Florida purportedly providing prescription drugsto M edicare beneficiaries.
CA RLO S J.G A RC IA ,a resident of Palm Beach County,w as the presidentand
registered agentofCapitalD rugs,and a beneficialownerofG reen H ope and Am erican D rugs.
12.

G ISELL A BER ASTUR IA , a resident of M iam i-Dade County and a licensed

pharm acy technician,w asem ployed atCapitaland w as the presidentand registered agentofGreen
H ope.

H EID Y G AR C IA , a resident of M iam i-D ade County,w as a licensed phannacy
teclm ician and em ployed atCapitalDrug,G reen H ope and A m erican Drug.

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 4 of 14

CO UN T 1
CO N SPIR AC Y TO CO M M IT H EA LTH CA RE FR AU D AN D W IRE FR AU D

(18U.S.C.5 1349)
TheGeneralAllegationssection ofthisIndictm entisrealleged and incorporated by
reference asthough fully setforth herein.

From in or around A plil2012,and through the date ofthis lndictm ent,in M iam iDade and Palm Beach Counties,in the Southern D istrictofFlorida,and elsewhere,the defendants,
CA RLO S J.G A RC IA,
G ISELL A BER ASTU RIA ,and
H EIDY G A R CIA ,

didwillfully,thatis,withtheintenttofurthertheobjectsoftheconspiracy,andknowinglycombine,
conspire,confederate and agree w ith each otherand others,know n and urlknown to the Grand Jury,
to com m itoffensesagainstthe U nited States,thatis:
to know ingly and w illfully execute a schem e and artifice to defraud a health care

benefitprogram affecting commerce,asdefined in Title 18,United StatesCode,Section 24(b),
specifically,M edicare and M edicare drug plan sponsors,and to obtain,by m eansofm aterially false
and fraudulentpretenses,representations,and prom ises,m oney and property owned by,and under
thecustody and controlof,said health care benefitprogram s,in connection w ith the delivery ofand
paym entforhealth care benefits,item s,and selwices,in violation ofTitle 18,U nited States Code,
Section 1347.
,and

b.

to knowingly and with the intentto defraud,devise and intend to devise a scheme

and artifice to defraud and for obtaining m oney and property by m eans of m aterially false and
fraudulentpretenses,representations,and prom ises,knowing the pretenses,representations,and

prom ises were false and fraudulentw hen m ade,and for the purpose of executing the schem e and

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 5 of 14

artifice,did knowingly transm itand cause to be transm itted by m eans of w ire com m unication in
interstate and foreign com m erce,certain w ritings,signs,signals,pictures and sounds,in violation
ofTitle 18,United States Code,Section 1343.

PU R PO SE O F TH E CO N SPIM C Y

Itwas apurpose ofthe conspiracy forthe defendantsand theirco-conspiratorsto

unlawfully enrich themselves by,among otherthings:(a)paying kickbacksforthereferralof
fraudulent M edicare beneticiary prescriptions to be used at Capital D rugs, Green H ope and

AmericanDrugs;(b)submittingandcausingthesubmissionoffalseandfraudulentclaimstohealth
carebenefitprograms;(c)concealingthesubmissionoffalseand fraudulentclaimstohealth care
benefitprograms,and thereceiptandtransferoffraudproceeds;and (d)divertingfraudproceeds
forthe personaluse and benefitofthem selves and others,and to furtherthe fraud.
M AN N ER A N D M EAN S O F TH E C O N SPIR AC Y

The m anner and m eans by which the defendants and their co-conspirators sought to

accomplishtheobjectsandpurposeoftheconspiracyincluded,amongotherthings,thefollowing:
4.

CA R LO S J.G AR C IA ,G ISELL A BEITA STU RIA and theirco-conspiratorspaid

kickbacks to recruiters for the referral of M edicare beneficiary prescriptions for use in false and
fraudulent billing of thc M edicare Part D Program through Capital D rugs, Green Hope and
A m erican D rugs.
CA R LO S J.G A RC IA ,G ISEL L A BER ASTU RIA ,H E ID Y GA R CIA and their
co-conspirators subm itted and caused the subm ission of claim s to the M edicare PartD Program ,

via electronic w ire com m unications,thatfalsely and fraudulently represented that various health

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 6 of 14

carebenefits,primarily prescription drugs,werem edically necessary and hadbeen provided to the
M edicare beneficiariesby CapitalDrugs,G reen Hope and Am erican Drugs.
A s a result of such false and fraudulent claim s,M edicare prescription dnlg plan

sponsors,through theirPBM S,madeoverpaymentsfunded by theM edicare PartD Program to the
corporate bank accounts of CapitalDrugs,Green H ope and A m erican Drugs in the am ount ofat

leastapproxim ately $2,500,000.
CA RL O S J.GA R CIA ,G ISELL A BEM STUR IA ,H EID Y G A R CIA and their

co-conspiratorsused the proceedsfrom the false and fraudulentM edicare PartD claim sfortheir

ownuseandtheuseofothers,andtofurthertheiaud.
Allin violation ofTitle 18,U nited StatesCode,Section 1349.
C O U N TS 2-10
H EA LTH C A RE FR AU D

(18U.S.C.5 1347)
The G eneralA llegations section ofthis Indictm entisrealleged and incolporated by
reference as though fully setforth herein.

From in or around A pril2012,and through the date ofthis Indictm ent,in M iam i-

Dade and Palm Beach Counties,in the Southern DistrictofFlorida,and elsewhere,the defendants,
C AR LO S J.G AR CIA ,
G ISE LL AB EM STU RIA ,and
H EID Y G A R CIA,

in connection w ith the delivery of and paym ent for health care benefits,item s,and services,did
knowingly and w illfully execute,and attem ptto execute,a schem e and artifice to defraud a health

carebenefitprogram affectingcommerce,asdefinedbyTitlel8,UnitedStatesCode,Section24(b),
thatis,M edicare and M edicare drug plan sponsors,and to obtain,by m eansofm aterially false and

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 7 of 14

fraudulentpretenses,representations,and prom ises,m oney and property owned by,and underthe
custody and controlof,said health care benefitprogram s.
Purpose ofthe Schem e and Artifice

ltw asapurpose ofthe schem e and artifice forthe defendants and theiraccom plices

to unlawfully enrich themselvesby,among otherthings:(a)payingkickbacksforthereferralof
fraudulent M edicare beneficial'
y prescriptions to be used at Capital D rugs, Green H ope and

AmericanDrugs;(b)submittingandcausingthesubmissionoffalseandfraudulentclaimstohealth
carebenefitprograms;(c)concealingthesubmission offalseandfraudulentclaimstohealthcare
benefitprograms,andthereceiptandtransferoffraudproceeds;and(d)diverting fraudproceeds
forthepersonaluseandbenefitofthem selvesand others,and to furtherthefraud.

TheSchem eand Artifice
4.

The M anner and M eans section of Count l of this lndictm ent is realleged and

incorporated by reference asthough fully setforth herein asa description ofthe schem eand artifice.
A cts in Execution orA ttem pted Execution ofthe Schem e and A rtifice

On or aboutthe dates set forth as to each countbelow ,in M iam i-Dade and Palm
Beach Counties,in the Southern D istrictofFlorida,and elsew here,the defendants,in connection
w ith the delivery ofand paym entfor health care benefits,item s,and services,did know ingly and

willfully execute,and attemptto execute,the above-described schem e and artifice to defraud a
healthcarebenetitprogram affectingcom merce,asdefinedbyTitle 18,United StatesCode,Section

24(b),thatis,M edicareand M edicaredrugplan sponsors,and to obtain,by meansofmaterially
false and fraudulentpretenses,representations,and prom ises,m oney and property ow ned by,and

underthe custody and controlof,said health carebenefitprogram s,in thatthe defendants subm itted

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 8 of 14

and eausedthesubm ission offalse andfraudulentclaimsseekingtheidentified dollaram ounts, and
representing that the identified pharm acy provided drugs to M edicare beneficiaries pursuant to
physicians'valid orders and prescriptions:
Count

D efendants

2

CARLOSJ G A R CIA ,

3

.

5

6

M edicare C laim
N um ber

09/18/2014;

GISELL ABERASTIJRIA,

Green H ope;

and H EID Y G AR C IA

T.D .

14261339778600

ltem C laim ed;
A pprox.
A m ount
C laim ed
Abijjs vabatj

:999

M G ;$1099

C AR LO S J.G A R CIA ,

11/19/2014;

59587444352383

SeroquelX R ;

GISELL ABERASTURIA,

Green Hope;

10602929212351

$1288

and H EID Y G AR C IA

4

D ate;
Pharm acy;
M edicare
B eneficiary

sA

352459404381

cA luao s J.G A R CIA ,

12/18/2014;

93384425352383

AdvairD iskus;

GISELL ABERASTURIA,

Green Hope;

10600719727225

$296

and H EID Y G A R CIA

S.A .

382400504381

cA lttuo s J.G A R CIA,

02/17/20154

95538592089231

AdvairD iskus;

GISELL ABEIU STURIA,

$303

Green Hope;

31506701710282

and H EIDY G A R CIA

-f'o .

896901504072

CA RLO S J.G AR C IA

03/30/2017;

17089513304317

SeroquelX R;

and HEIDY G ARCIA

Am erican

79939110

$1529

17146394443211
19988866

N am enda X R
Cap 14 M G ;

D rugs;
A .R.

7

CA RLO S J.G AR C IA
and H EID Y G AR C IA

05/26/2017;
A m erican

Drugs;

$395

M .B .
8

CA RLO S J.G AR C IA
and H EID Y G AR C IA

08/16/2017;
A merican
o rugs;
A .R .

17228400129610

SeroquelX R;

89989110

$1529

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 9 of 14

C ount

D efendants

D ate;
Pharm acy;
M edicare
B eneficiary

M edicare C laim
N um ber

ltem C laim ed;
A pprox.
X m ount
Claim ed

9

CA R LO S J.G A RC IA

09/01/20174

17244408474519

Januvia Tab 25

and H EIDV GARCIA

American

29999110

M G;$8ll

18032483075505
29999110

N am enda X R
Cap 14 M G ;

Dnzgs;
M .B .

10

CA R LO S J.

G A RC IA

and HEIDY GARCIA

02/01/2018)
A
m erican

orugs;

$430

M .B .

ln violation ofTitle 18,U nited States Code,Sections l347 and 2.
FO R FEITU R E

(18U.S.C.5982(a)(7))
The allegations contained in this Indictm ent are realleged and incorporated by
reference as though fully setforth herein forthe purpose ofalleging forfeiture to the United States
ofcertain property in which defendants CA RL O S J.G A RC IA, G ISELL A BER A SU RIA ,and
H EID Y G A RC IA have an interest.

Upon conviction ofany violation ofTitle18,United StatesCode,Sections1347 and
1349,as alleged in Counts l through 10 ofthe Indictm ent,the defendantso convicted shallforfeit
to the United States al1of his or her right,title and interestin any property,realorpersonal,that
constitutes oris derived,directly orindirectly,from gross proceedstraceable to the com m ission of

suchviolations,pursuanttoTitle18,UnitedStatesCode,Section982(a)(7).
Thepropertysubjecttoforfeitureincludes,butisnotlimitedto,thesum ofatleast
$2,500,000inUnited Statescun-ency,which isasum ofmoneyequalin valueto thegrossproceeds

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 10 of 14

traceable to the com m ission ofthe violations alleged in this lndictm ent,which the U nited States

willseekasaforfeituremoneyjudgmentaspartofthedefendants'sentence.
A11pursuanttoTitle18,United StatesCode,Sections982(a)(1)and 982(a)(7);andthe
proceduressetforth atTitle 21,United StatesCode,Section 853,as m ade applicable through

Title 18,UnitedStatesCode,Section 982(b)(1).

FO 1

(

-t-

BE A M m G .GREEN BER
U NITED STATES ATTO RN EY

ï

G

JON M U EN GER
A SSISTA N T U .S.A TTORN EY

 U NITED 3
STATES
D ISTRI
CO URT
Case 1:18-cr-20514-KMM Document
Entered
on CT
FLSD
Docket 06/15/2018 Page 11 of 14
SO UTH ER N DISTRICT O F FLO RIDA

UN ITED STATES O F AM ER ICA

C ASE NO .

CAR LO SJ.GA RCIA,G ISELL ABEM STU IA,

andHEIDY GARCIA

C ERTIFICATE O F TRIA L A TTO RNEY.
Defendants.

/

CourtDivision:(selectone)
-

X

:lianai
FTL

Superseding Case lnform ation:

New Defendantts)

Key sVest
SVPB
FTP

Yes

NumberofN ew Defendants
Totalnumberofcounts

No

ldo hereby certify that:
lhave carefully considered the allegations ofthe indictm ent,the numberofdefendants,the number
ofprobable witnessesand the legalcomplexitiesofthe lndictment/lnform ation attached hereto.

1am aF are thatthe information supplied op thisstatem entw illberelied upon by theJudgesofthis
Courtln setting theircalendarsand schedullng crim inaltrialsunderthe mandate ofthe Speedy Trial

Act,Title28 U .S.C.Section 3161.

lnterpreter:

(YesorNo)

Listlanguage and/ordialect
Thiscasew illtake

5

YES
1SH

daysforthe partiesto try.

Please check appropriate category and type ofoffenselisted below :
(Checkonlyone)

(Checkonlyone)

l
11
I1l
IV
V

0 to 5 days
6 to 10 days
l1 to 20 days
2lto 60 days
61daysand over

6

Hasthiscasebeenpreviously filed in thisDistrictCourt? (YesorNo) NO

.

lfyes:
Judge:

X

Petty
M inor
M isdem .
Felony

Case No.

(Attachcopy pfdispositiveordel)
Hasacomplamtbeenfiledinthlsmatter?

(YesorNo)

Ifyes:
M agistrate CaseN o.
Related M iscellaneousnumbers:

Defendantts)infederalcustodyasof
Defendantts)instatycpstody asof
Rule20 from theDlstrlctof
lsthisapotentialdeathpenalty case?(YesorNo)

NQ

Dpesthiscase originate from am atterpending in theN orthern Region ofthe U.S.Attorney'sOffice
prlorto October14,2003?

Yes

.- .
,..

. - . - -....

No

...-.

X

-

-

Jon Ju e
A ssist tU nited StatesA ttorney
Florida BarN o.:56108

*penalty Sheetts)attached

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 12 of 14

UN ITED STA TE S D ISTRIC T CO UR T
SO U TH ER N D ISTRIC T O F FLO R ID A
PEN A LTY SH EET
D efendant's N am e:CA RLO S G A RC IA
C ase N o:

Count#:1
Conspiracy to Com m itHea1th Cam Fraud and W ire Fraud
Title 18.United StatesCode,Section 1349

*M ax.Penalty:Twenty(20)years'imprisonment
Counts #:2-10

H ea1th Care Fraud
Title 18.United StatesCode.Section 1347

*M ax.Penalty:Ten(10)years'imprisonmentastoeachcount

eR efers only to possible term ofincarceration,doesnotinclude possible fines,restitution,
sped alassessm ents,parole term s,or forfeituresthatm ay be applicable.

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 13 of 14

U NITED STA TES D ISTRIC T C O U RT
SO U TH E RN DISTRICT O F FLO R IDA
PEN A LTY SH EET

D efendant'sN am e:G ISELL A BERASTU RIA
C ase No:

Count#:l
Conspiracy to Com m itH ealth Care Fraud and W ire Fraud
Title 18sUnited StatesCodesSection 1349

*M ax.Penalty:Twenty(20)years'imprisomnent
Counts#:2-5

Health Care Fraud
Title 18.United States CodesSedion 1347

*M ax.Penalty:Ten(10)years'imprijonpeptastoeachcount

eRefersonly to possible term ofincarceration,does notinclude possible fines,restitution,
specialassessm ents,parole term sror forfeitures that m ay be applicable.

 Case 1:18-cr-20514-KMM Document 3 Entered on FLSD Docket 06/15/2018 Page 14 of 14

UN ITE D STA TES DISTR IC T CO U R T
SO U TH ER N D ISTRICT O F FL O R IDA
PEN A LTY SH EET
D efendant's N am e:H EIDY GA RC IA
C ase N o:

Count#:1
Conspiracy to Com m itHea1th Care Fraud and W ire Fraud
Title l8.United States CodesSection 1349

*M ax.Penalty:Twenty(20)years'implisonment
Counts #:2-10

H ealth Care Fraud
Title 18,United States Code.Section 1347

*M ax.Penalty:Ten (10)years'imprisonmentastoeachcount

*Refers only to possible term ofincarceration,does notinclude possible fines,restitution,
spedalassessm ents,parole term s,or forfeitures thatm ay be applicable.