MIAMI, Fla. — A detox facility owner has been charged with health care fraud for allegedly defrauding the Federal Employees Health Benefits Program (FEHBP) of over $4 million, said the U.S. Attorney’s Office for the Southern District of Florida (USAO).
According to the allegations in the information, Joseph Toro, 39, of Jupiter, Florida, owned and operated Reawakenings Wellness Center (RWC), a detox facility that provided substance abuse treatment to patients, including FEHBP beneficiaries.
Allegedly, after RWC closed in January 2018, Toro continued to submit insurance claims, using personal identifying information (PII) of former RWC patients, for substance abuse treatment that was never provided, the USAO said.
As a result of these false and fraudulent insurance claims, Toro allegedly defrauded the FEHBP and Blue Cross Blue Shield (BCBS), which administers some FEHBP insurance plans, of more than $4 million in federal employee health benefits.
Toro allegedly used the fraud proceeds to buy properties, luxury vehicles, and a luxury watch.
If convicted, Toro faces up to 10 years in federal prison.
U.S. Attorney Markenzy Lapointe for the Southern District of Florida and Special Agent in Charge Derek Holt of the U.S. Office of Personnel Management Office of the Inspector General (OPM OIG), announced the charges.
OPM OIG investigated the case. Assistant U.S. Attorney Joseph Egozi is prosecuting it. Assistant U.S. Attorney Joshua Paster is handling asset forfeiture.
An information contains mere allegations, and all defendants are presumed innocent unless and until proven guilty in a court of law.
