MIAMI - In Cuba, many neighborhoods had clinics. Families gave them a little money each week, and when they were sick, the clinic took care of them.

In Miami, in the early 1960s, as the new Cuban immigrants struggled to make ends meet, a group of physicians and others, including Benjamin Leon Sr., an accountant, set up the Clinica Cubana in Little Havana.

The original monthly fee in 1964 was $2 for an individual and $5 for a family, recalls Benjamin Leon Jr., who later was chief executive of what became known as Clinica Asociacion Cubana, then Comprehensive American Care, then simply CAC.

The first clinic was open 7 a.m. to 11 p.m., and in the beginning the Cuban doctors, without Florida licenses, operated under the loose supervision of a U.S.-trained physician.

The Cuban concept was personal service. The waiting room was a meeting place, where patients could have a cafecito and maybe a snack, and spend time chatting with friends and catching up with the news.

In the 1970s, CAC became a licensed health maintenance organization. Competitors appeared. The biggest was International Medical Centers, led by Miguel Recarey Jr., who had been jailed for failing to file tax returns and arrested for getting in a fist fight with a Saudi diplomat. With a $4,000 investment, International Medical Centers grew rapidly, buying a hospital and eventually getting more than $170 million a year from Medicare to treat seniors.

The battle with CAC led to cost-cutting wars, complaints from doctors that the HMOs weren't paying them, accusations of deceptive advertising, investigations for insolvency and charges that they were giving campaign contributions to local politicians in return for favors.

The accusations against CAC never led to anything, but in April 1987, Recarey and three others were indicted, accused of paying kickbacks to union leaders in return for their members joining IMC. Recarey fled overseas and was never tried. IMC was bought by Humana.

When Ramsey entered the market, HMOs in Florida were struggling. Collectively, they lost $123 million in 1988. But as employers battled to contain rising healthcare costs, the HMOs became popular, with primary care doctors serving as gatekeepers, controlling access to specialists and expensive tests.

In 1994, riding the crest of that success, Ramsey sold its local HMO and the CAC clinics to UnitedHealthcare for $500 million. The clinics lost members almost immediately. UHC, a Minneapolis-based firm, "didn't understand the culture," says former CAC Ramsey executive Mike Fernandez. They stopped the cafecitos. "They totally wasted their time and their money."

Two years later, Leon, whose noncompete agreement with CAC Ramsey had expired, opened his first Leon Medical Center in Little Havana - promoting the coffees and "warm and tender" service that UnitedHealthcare had abandoned.

At the time, HMOs were in a downswing. Many patients were angry at gatekeepers stopping them from getting treatments, and many insurers complained that Medicare wasn't paying HMOs enough - 95 percent of what the average senior's medical costs were in an area.

In 1999, UnitedHealthcare admitted defeat and sold all 18 CAC clinics to Pan American Hospital for an undisclosed amount. The hospital couldn't make them work. In 2001, it abruptly closed the remaining 12, throwing 1,000 people out of work.

Re-enter Fernandez, who had started a Medicare HMO that eventually became CarePlus. He bought the CAC clinics for "less than $100 million" and took them back to the original model - strong personal services and cafecitos. He also spruced up the centers, including the one on Bird Road, where he tripled the size and installed meeting rooms where seniors could get together.

Fernandez and Leon were battling a tough tide that caused Medicare HMOs in Florida to lose $72 million in 2000, but that changed with the Medicare Reform Act of 2003. Best known for offering a prescription drug benefit, the act also enriched the HMOs.

That made the Medicare HMOs and clinics more lucrative, and in December 2004 Fernandez sold CarePlus and the CAC clinics to Humana for $450 million.

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