MIAMI –The lead defendant in a 15-defendant $36 million health care fraud conspiracy scheme was sentenced to prison last week.
Arisleidys Fernandez Delmas, 33, of Miami, Florida, was sentenced to 104 months in federal prison, followed by three years of supervised release, and ordered to pay restitution in the amount of $8,671,377 for her participation in a health care fraud conspiracy that billed Blue Cross Blue Shield (“BCBS”) for more than $36 million for physical therapy services that patients never received.
Fernandez Delmas and 11 other defendants have pleaded guilty in federal court in South Florida for their participation in the scheme, according to the U.S. Attorney’s Office for the Southern District of Florida (USAO).
According to the factual proffers filed with the court, from August 2018 to February 2023, co-conspirators in the scheme paid kickbacks to beneficiaries of health insurance plans managed by BCBS. The co-conspirators offered these kickbacks to employees of JetBlue Airways, AT&T Inc., and TJX Companies Inc. to induce the beneficiaries to serve as patients at 30 South Florida physical therapy clinics.
Reportedly, the co-conspirators who owned the clinics then submitted fraudulent health insurance claims to BCBS for health care benefits that were medically unnecessary and not even provided.
According to the court documents, these co-conspirators also paid kickbacks and bribes to their co-defendants in return for referring additional BCBS beneficiaries to the physical therapy clinics so more fraudulent healthcare claims could be submitted.
These co-conspirators also paid licensed massage therapists—several of whom were among the defendants convicted—to act as “nominee owners” and operators of the physical therapy clinics. This reportedly allowed the scheme leaders to avoid various medical clinic licensing requirements and attempt to evade criminal prosecution.
The following defendants have pleaded guilty for their involvement in the fraudulent physical therapy billing scheme:
- Pedro Hugo Prieto Garcia, of Miami
- Leidys Delmas Garcia, of Miami
- Carlos Jose Martin Gomez, of Miami
- Julio Acosta Perez, of Homestead
- Yohana Iriza (aka Yohana Lozada), of Miami
- Gabriel Lozada, of Fort Meyers
- Emiliano Joaquin Garcia, of Lakeland
- Anthony Lozada, of Miami
- Daimara Borroto Garcia, of Hollywood
- Elias Caises Maurino, of Miami
- Linda Taylor, of Miami
The following three other defendants have made their initial appearances in federal court:
- Gabriel Jaime Mejia, of Miami
- Yarlon Valdes Morejon, of Miami
- Ariel Gonzalez, of Naples
A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty in a court of law.
U.S. Attorney Markenzy Lapointe for the Southern District of Florida and Special Agent in Charge Jeffrey B. Veltri of FBI, Miami Field Office, made the announcement.
FBI Miami investigated the cases. Assistant U.S. Attorneys Will J. Rosenzweig and Michael B. Homer are prosecuting them. Assistant U.S. Attorney Annika Miranda is handling asset forfeiture.