FLORIDA – Nine Florida residents have been arrested for charges related to orchestrating an alleged $37 million health care fraud scheme, the U.S. Attorney’s Office for the Southern District of Florida has announced.
The nine were arrested last week by the Federal Bureau of Investigation (FBI) after being charged by a federal grand jury in Miami with health care fraud and conspiracy to commit health care fraud. The fraud scheme allegedly involved tens of millions of dollars in fraudulent health care billing by 30 south Florida physical therapy clinics.
According to allegations in three related indictments and statements by the government in federal court, the defendants conspired to submit approximately $37 million in fraudulent health care claims to Blue Cross Blue Shield.
The defendants are identified as Arisleidys Fernandez Delmas, 32; her mother, Leidys Delmas Garcia, 51; her husband, Pedro Hugo Prieto Garcia, 32; Daimara Borroto Garcia, 32; Elias Caises Maurino, 52; Yohana Iriza (a/k/a Yohana Lozada), 51; her ex-husband Gabriel Lozada, 50; their son Anthony Lozada, 23; and Julio Acosta Perez, 40, the USAO said.
According to allegations, from approximately 2018 to the present, the defendants allegedly paid kickbacks to beneficiaries of health insurance plans managed by Blue Cross. They allegedly offered these kickbacks to employees of JetBlue Airways, AT&T Inc., and TJX Companies Inc. to induce the beneficiaries to serve as patients at various South Florida physical therapy clinics. The defendants, who owned the clinics, then reportedly submitted fraudulent health insurance claims to Blue Cross for health care benefits that were medically unnecessary and not even provided.
The defendants also allegedly paid kickbacks and bribes to their co-defendants in return for referring additional Blue Cross beneficiaries to the physical therapy clinics so more fraudulent health care claims could be submitted, the USAO said in its statement.
According to the USAO, the defendants also allegedly paid licensed massage therapists—who also were arrested last week—to act as “nominee owners” and operators of the physical therapy clinics. This allowed the leaders of the scheme to avoid various medical clinic licensing requirements and attempt to evade criminal prosecution.
The indictments charge each defendant with multiple counts of conspiracy to commit health care fraud and health care fraud, the USAO said. If convicted, each defendant faces up to 10 years in prison per count. A federal district judge will determine any sentence after considering U.S. Sentencing Guidelines and other statutory factors.
An indictment is a charging instrument containing allegations. A defendant is presumed innocent unless and until proven guilty in a court of law.
Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida, and acting Special Agent in Charge Robert M. DeWitt, FBI, Miami Field Office, announced the charges.
FBI, Miami Field Office, investigated the case. Assistant U.S. Attorneys Michael B. Homer and Will Rosenzweig are prosecuting it.
Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.gov, under case numbers 22-cr-20560, 22-cr-20561, and 22-cr-20562.
