U.S. v. Pablo Orama, Vivian Augustine, a/k/a Vivian Salazar, Ariane ...

Case 1:12-cr-20265-DMM Document 27 Entered on FLSD Docket 04/19/2012 Page 1 of TB 12 

UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA 

Case No. 

UNITED STATES OF AM ERICA 

VS. 

12-20265-CR-MIDDLEBROOKS-M/GARBER 

PABLO OM MA and 

VIVIAN AUGUSTINE, 

a/k/a Sdvivian Salazarr' 

Defendants. 

The Grand Jury charges that: 

At a11 times material to this Indictment: 

/ 

18 U.S.C. j 371 

42 U.S.C. j 1320a-7b(b)(2)(A) 

18 U.S.C. j 982 

INDICTM ENT 

GENERAL ALLEGATIONS 

The Medicare Program 

The Medicare Program (liMedicart') was a federaly funded program that provided 

free or below-cost health care benefits to certain individuals, primarily the eldtrly, blind, and 

disabled. The benefits available under Medicare were governed by federal statutes and regulations. 

The United States Department of Hea1th and Human Services CiHHS'), through its agency, the 

Centers for Medicare and Medicaid Services (i$CMS'), oversaw and administered Medicare. 

lndividuals who received benestsunder Medicare were commonly referred to as Medicare 

Ssbeneficiaries.' 

Apr 19, 2012

Case 1:12-cr-20265-DMM Document 27 Entered on FLSD Docket 04/19/2012 Page 2 of 12 

2. Medicare was a tshealth care benefk programy' as defned by Title 18, United States 

Code, Section 24(b) and a Federal health care program, as defined by Title 42, United States Code, 

Section 1320a-7b(9. 

3. Medicare programs covering diferent types of benefits were separated into different 

program 'dparts.' tTm.t A' of the Medicare progrnm covered certain eligible home health care costs 

for medical services provided by a home health agency (ç$HHA'), also referred to as a fkprovider,' 

to persons who already qualitsed for Medicare and who additionaly required home health services 

because of an ilness or disability that caused them to be homebound. Payments for home health care 

medical services were typicaly made directly to a Medicare-certiftd HHA or provider based on 

claims submited to the Medicare program for qualifying services that had been provided to eligible 

beneficiaries. 

4. CMS did not directly pay Medicare Part A claims submited by Medicare-certified 

HHAS. CMS contracted with diferentprivate companies to administerthe Medicare Part A program 

throughout different parts of the United States. In the State of Florida, CMS contracted with 

Palmetto Govemment Benefhs Administrators (ûpalmeto'). As administrator, Palmetto was to 

receive, adjudicate and pay claims submited by HHA providers under the Part A program for home 

health claims. Additionally, CMS separately contracted with companies in order to review HHA 

providers' claims data. CMS tlrst contracted with Tricenturion, a Program Safeguard Contractor. 

Subsequently, on December 15, 2008, CMS contraded with SafeGuard Services, a Zone Program 

Integrity Contrador. Both Tricenturion and SafeGuard Servicts safeguarded the Medieare Trust 

Fund by reviewing HHA providers' claims for potential fraud, waste, and/or abuse. 

Home health care agencies, pharmacies, physicians, and other health care providers


that provided services to Medicare benetkiaries were able to apply for and obtain a Medicare 

Identification Number or Sçprovider number.' In the application, the provider acknowledged that to 

be able to participate in the Medicare program, the provider must comply with a11 Medicare related 

laws and regulations. A provider who was issued a Medicare Identification Number was able to file 

claims with Medicare to obtain reimbursement for services provided to benefciaries . The Medicare 

ldentilcation Number uniquely identifed the provider on billing forms submited to Medicare . 

6. The Medicare Part 

Part A Coverage and Regulations 

Reimbursements 

program reimbursed 100% of the allowable charges 

for participating HHAS providing home health care services only if the patient qualifed for home 

health benefits. A patient qualified for home health benetits only if the patient: 

(a) was confined to the home, also referred to as homebound; 

(b) was under the care of a physician who specifically determined there was a need for 

home health care and established the Plan of Care C$P.O.C.'); and 

(c) the determining physician signed a certification statement specifying that the 

beneficiary needed intermittent skiled nursing, physical therapy, speech therapy , or a 

continued need for occupational therapy; the beneficiary was confned to the home; that a 

POC for fumishing services was established and periodicaly reviewed; and that the services 

were furnished while the beneficiary was under the care of the physician who established the 

P.O.C. 

The Defendants and their Company 

Superstar Home Hea1th Care, lnc. Csuperstar') was incomorated on or about April


18, 2006, and did business in Miami-Dade County, providing home health services to Medicare 

benesciaries. Superstar applied for and received Medicare Identication Number 10-9473 . 

8. On or about April 24, 2009, defendant VIVIAN AUGUSTINE, a/k/a dsvivian 

Salazar,' became the vice-president, director, and registered agent , of Superstar. On or about 

December 7, 2009, AUGUSTINE, underthe name çdvivian Salazar ,' became president and director 

of Superstar. 

Defendant PABLO ORAMA had an ownership interest in Superstar . 

10. Individual 1 was employed by Superstar from on or about August 1 1 , 2010, until on 

or about January 30, 2012. 

COUNT 1 

Conspiracy to Pay HtaIth Care Kitkbacks 

(18 U.S.C. j 371) 

Paragraphs 1 through 10 of the General Allegations sedion of this lndictment are re- 

aleged and incorporated by reference as though fully set forth herein. 

2. Beginning on or about August 20, 2010, and continuing through on or about April 

3, 2012, in Minmi-Dade County, in the Southern District of Florida, and elsewhere, the defendants , 

PABLO ORAMA and 

VIVIAN AUGUSTINE, 

a/k/a dvivian Salazar,' 

did wilfuly, that is, with the intent to further the object of the conspiracy, and knowingly combine, 

conspire, confederate and agree with each other, and others known and unknown to the Grand Jury , 

to commit an offense against the United States, that is, to violate Title 42, United States Code , 

Section 1320a-7b(b)(2)(A), by knowingly and willfuly offering and paying any remuneration, 

including kickbacks and bribes, directly and indirectly, overtly and covertly, in cash and in kind , to 

4


aperson to induce such person to refer an individual to a person for the furnishing and arranging for 

the fumishing of an item and service for which payment may be made in whole and in part by a 

Federal health care program, that is, Medicare. 

Purpose of the Conspiracy 

It was the purpose of the conspiracy for the defendants and their co-conspirators to 

unlawfuly enrich themselves by: (1) paying kickbacks and bribes to ensure that Medicare 

benefciarieswould serve as patients at Superstar, and (2) by submiting claims to Medicare for home 

health services that Superstar provided to those beneficiaries. 

M anner and M eans of the Conspiracy 

The manner and means by which the defendants and their co-conspirators sought to 

accomplish the object and purpose of the conspiracy included, nmong others, the folowing: 

1. PABLO ORAM A, VIVIAN AUGUSTINE, and others offered and paid kickbacks 

and bribes to individuals for recruiting Medicare beneficiaries to receive medical services from 

Superstar. 

PABLO ORAM A and VIVIAN AUGUSTINE gave lndividual 1 cash to pay 

kickbacks and bribes to Medicare beneticiaries for receiving medical services through Suptrstar . 

PABLO ORAMA and VIVIAN AUGUSTINE caused Superstar to submit claims 

to Medicare for home health services purportedly rendered to Medicare benesciaries . 

4. PABLO OM MA and VIVIAN AUGUSTINE eaused Medicare to pay Superstar 

based upon home health services purportedly rendered to Medicare beneficiaries . 

Overt Acts 

ln furtherance of the conspiracy, and to accomplish its object and pupose, at least one of the


co-conspirators commited and caused to be committed , in the Southem District of Florida, at least 

one of the folowing overt acts, among others: 

On or about November 2, 201 1, VIVIAN AUGUSTINE gave lndividual l 

approximately $7,900 in cash to pay kickbacks to Medicare beneficiaries for serving as patients at 

Superstar. 

On or about November 3, 201 1,VIVIAN AUGUSTINE gave lndividual 1 


Superstar. 

On or about November 4,201 1, VIVIAN AUGUSTINE gave Individual 1 


Superstar. 

Onor aboutNovember 22, 201 1, PABLO ORAMA gave lndividual 1 approximately 

$4,400 in cash to pay kickbacks to Medicare beneiciaries for serving as patients at Superstar. 

5. On or about November 30, 201 I,PABLO ORAMA gave Individual 1 approximately 

$9,600 in cash to pay kickbacks to Medicare beneficiaries for serving as patients at Superstar . 

6. On or about December 16, 201 1, VIVIAN AUGUSTINE gave lndividual 1 


Superstar. 

gave lndividual 1 


Superstar. 

On or about January 6, 2012, VIVIAN AUGUSTINE 

8. On or about Janumy 2012, VIVIAN AUGUSTINE gave Individual 1



Superstar. 

All in violation of Title 18, United States Code, Section 371 . 

COUNTS 2-14 

Payment of Kiekbaclts in Connection with a Federal HeaIth Care Program 

(42 U.S.C. j 1320a-7b(b)(2)(A)) 

1. Paragraphs 1 through 10 of the General Allegations section of this Indictment are re- 

aleged and incorporated by reference as though fuly set forth herein . 

On or about the dates enumerated below as to each count, in M iami-Dade County , 

in the Southern District of Florida, and elsewhere, the defendants as specified below , did knowingly 

and willfuly ofer and pay any remuneration, that is, kickbacks and bribes , in cash and in kind, that 

is, in the form of cash or other consideration, directly and indirectly, overtly and covertly , to a 

person, to induce such person to refer an individual for the furnishing and arranging for the 

furnishing of any item and service for which payment may be made in whole or in part by Medicare , 

as set forth below: 

Count Defendantts) Approximate Approximate Person 

Date Kickback Amount Paid 

2 VIVIAN AUGUSTINE 1 1/03/201 1 $3,000 M,G. . 

3 VIVIAN AUGUSTINE 1 1/03/201 1 $1,600 W j?( 

4 VIVIAN AUGUSTINE 1 1/04/2011 $1,200 M.R. 

5 PABLO ORAMA and 1 1/09/201 1 $1,600 J.C.H. 

VIVIAN AUGUSTINE 

6 PABLO ORAMA 1 1/22/2011 $3,000 J.C.H. 

7 PABLO ORAMA 11/30/201 1 $1,000 Y.P.R. 

8 PABLO ORAMA 1 1/30/201 1 $1,500 J.A. 

7


Count Defendant Approximate Approximate Personts) 

Date Kickback Amount Paid 

9 VIVIAN AUGUSTINE 12/16/201 1 $1 ,000 O.A. 

10 VIVIAN AUGUSTINE 12/19/2011 $3 ,000 C,A,H. 

1 1 VIVIAN AUGUSTINE 12/22/201 1 $2 ,600 I.P. 

12 VIVIAN AUGUSTINE 01/06/2012 $1,500 J .C.H. 

13 VIVIAN AUGUSTINE 01/13/2012 $1 ,300 I.P. 

14 VIVIAN AUGUSTINE 01/19/2012 $1 ,000 E.C. 

In violation of Title 42, United States Code, Section 1320a-7b(b)(2)(A), and Title 18 , United 

States Code, Section 2. 

FORFEITU- RE 

(18 U.S.C. j 982 (a)(7) 

The alegations contained in this Indictment are realeged and incomorated by 

reference as though fuly set forth herein for the purpose of aleging forfeiture to the United States 

of America of certain property in which defendants , PABLO ORAM A and VIVIAN 

AUGUSTINE, have an interest. 

Upon conviction of any violation of Title 18, United States Code , Section 371, or 

Title 42, United States Code, Section l 320a-7(b), as aleged in Counts1 through 14 of this 

Indictment, the defendants, PABLO ORAMA and VIVIAN AUGUSTINE , shal forfeit to the 

United States, any property, real or personal, that constitutes or is derived , directly or indirectly, from 

gross proceeds traceable to the commission of the offense, pursuant to Title 18 , United States Code, 

Sections 982 (a)(7). 

Al1 pursuant to Title 18, United States Code, Section 982(a)(7) and the procedures set forth 

8


at Title 21, United States Code, Section 853, made applicable by Title 18 , United States Code, 

Section 982(b). 

t / O.L $ 

A 

WIFREDO A. FERRER 

IJNITED STATES ATTORNEY 

h 

. M L S 

ASSISTANT U.S. ATTORNEY 

9 

AJX'YE BILL


Case 1:12-cr-20265-DMM Document SOUTHERN 27 Entered DISTRICT on OF FLSD FLORIDA Docket 04/19/2012 Page 10 of 12 

UNITED STATES OF AMERICA 

V*. 

PABLO ORAMA and 

VIVIAN AU9USTINE 

a/k/a 'vivlan salazlr,' 

Coud Division: (select one) 

Defendants. l 

Y FTL Miami wKe 

IB West FTp 

I do hereby certify that: 

2 . 

3. 

4 . 

CASE NO. 

CERTIFICATE OF TRIAL ATTORNEY* 

Supeoeding Case Information: 

New Defendants) Yes No 

Number of New Defendants 

Total number of counts 

I have carefuly considered the alegations pf the indictmqnt the number qf defendants the number of 

probable witnesses and the Iegal complexlties of the IndlctMent/lnformatlon atached hereto. 

I am Mware that the information supplied Mn thij qtatement wil be relied upon b ythe 

Ju d qes 

of this 

Coud In setti n qtheir 

calendars and schedulng crlmlnal trlals underthe mandate ofthe 

Speed-y Trial Act, 

Title 28 U.S. C'. Section 3161 . 

Interpreter: List Ianguage and/or (Yes dialec or Nj Mn 

This case wil take B 

6. If Has this case been previoussy filed in this District Court? (Yes or No) Nn 

yes: 

Judge: Case No. 

(Atach H copy 9f dispositive grdej 

as a complalnt been filed ln thls mater? (Yes or No) Mon 

lf 

Maglstrate yep: 

Case No. 12-MJ-02447-RLD 

Related Misc#laneous numbers: 

Defendants) ln federal custody as of 

Defendants) In state custody as of 

Rule 20 from the District of 

Is this a potential death penalty case? (Yes or No) 

*penalty Sheetls) atached 

days for the padies to try. 

Please check appropriate category and type of offense Iisted below: 

(Check only one) (Check only one) 

0 to 5 days X P#ty 

6 to 10 days Mlnor 

11 to 20 days Mlsdem. 

21 to 60 days Felony 

61 days and over 

Doesthis case or gi inatefrom a matter pending in the Nodhern Region of the U.S. Attorney's Office prior 

G0 3? Yes X No 

to October 14, 2 

Does this case ori inate from a matter pending in the Central Region of the 

to September 1 , 2107? 

Yes x No 

U.S. Atorney's Ofice prior 

ER MO ALES 

AS>ISTANT UNITED STATES ATTORNEY 

Fl orlda Bar No./court No. A5500886 

REV 4/8/08


Defendant's Name: PABLO ORAMA 

Case No: 

Count #: 1 

Conspiracy to Pay Health Care Kickbacks 

Title 1 8, United States Code, Section 371 

* Max. Penalty: Five (5) years' imprisonment 

Counts #: 5 - 8 



PENALTY SHEET 

Payment of Kickbacks in Connection with a Federal Hea1th Care Program 

Title 42, United States Code, Section 1320a-7b(b)(2)(A) 

*Max. Penalty: Five (5) years' imprisonment as to each count 

Count #: 

*Max. Penalty: 

Count #: 


* Refers only to possible fine, does not include possible restitution , special assessments, parole 

terms, or forfeitures that may be applicable.




PENALTY SHEET 

Defendant's Name: VIVIAN AUGUSTINE. a/k/a idvivian Salazar' 

Case No: 

Count #: 1 

Conspiracy to Pay Health Care Kickbacks 

Title 18, United States Code, Section 371 

# Max. Penalty: Five (5) years' imprisonment 

Counts #: 2 - 5, and 9 - 14 

Payment of Kickbacks in Connection with a Federal Health Care Program 

Title 42, United States Code, Section 1320a-7b(b)(2)(A) 

*Max. Penalty: Fivqls.) yç>p' imprisonmelg as to each count 

Count #: 


Count #: 


# Refers only to possible fine, does not include possible restitution , special assessments, parole 

terms, or forfeitures that may be applicable.

U.S. v. Pablo Orama, Vivian Augustine, a/k/a Vivian Salazar, Ariane ...

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