Miami man sentenced to over five years for Medicaid fraud scheme

FLORIDA — A Miami man has been sentenced to over five years in federal prison for his role in a Medicaid fraud scheme totaling nearly $3.9 million, the U.S. Attorney’s Office for the Southern District of Florida (USAO) has announced.

Jose Davila Nunez, 51, was sentenced on Oct. 11 to 63 months in prison, followed by three years of supervised release, and was ordered to pay $3,869,703 in restitution.

According to court records, Mr Davila and his co-conspirators established a mental health clinic, New Behavior Health Direction, Inc., in Hialeah Gardens, appointing a nominee owner to conceal their involvement.

From April 2019 to September 2020, the group submitted fraudulent claims to Medicaid for psychosocial rehabilitation services intended to aid individuals with mental health issues.

In September 2020, the nominee withdrew the fraud proceeds, provided a portion to Davila, and fled to Cuba. Mr Davila’s business, Max Medical Consulting Services, Inc., reportedly received around $500,000 from these illicit funds.

The USAO said Davila was also implicated in additional fraudulent activity involving $2,617,992 in illegal bribes to patients in exchange for Medicaid-reimbursed services at three other Miami clinics. These clinics included Davila Medical Center, Inc., Advanced Community Wellness Center, and Larkin Behavior Health, Inc.

As part of the investigation, authorities seized approximately $1.7 million in funds tied to New Behavior’s bank accounts.

The case was investigated by the U.S. Department of Health and Human Services Office of Inspector General, the FBI’s Miami Field Office, and the Florida Office of the Attorney General Medicaid Fraud Control Unit. Markenzy Lapointe, U.S. Attorney for the Southern District of Florida, made the announcement, with AUSA Timothy Abraham prosecuting the case and Assistant U.S. Attorney Jorge Delgado managing asset forfeiture.