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Eleven indicted for signing up foreigners for Medicare in $25M fraud

Eleven South Florida residents were indicted on federal charges of defrauding Medicare and Medicaid by signing up enrollees in foreign countries.

Those indicted include a physician and employees of Coral Gables-based HMO Florida Healthcare Plus. The HMO was suspended by the Florida Office of Insurance Regulation in September and regulators have since moved to liquidate the company in state administrative court.

According to the charges filed by the U.S. Attorney for the Southern District of Florida, the defendants had people living in Nicaragua and the Dominican Republic enroll in Medicare Advantage HMO plans and Florida Medicaid while selecting Miami doctors as their primary care physicians. The applications falsely stated that the enrollees lived in Florida.

The defendants allegedly paid for them to travel to Florida for care and then shared the $25.2 million that Medicare and Medicaid paid to Florida Healthcare Plus and the physicians.

Federal authorities obtained a court order to freeze $10 million in asset belonging to the defendants.

“Unfortunately, scams that bilk our health care system do not stop at our borders,” said George L. Piro, special agent in charge of the FBI in Miami said in a news release. “These fraudsters sought out and recruited residents of Nicaragua and the Dominican Republic to swindle U.S. taxpayer dollars from the Medicare and Medicaid programs. We are pleased to have put these unscrupulous operators out of business.”

The indicted individuals are Pedro Hernandez of Miramar, the former COO of Florida Healthcare Plus; Freddy Zeron of Miami, the owner of an allegedly fraudulent clinic;Erendira V. Delgado of Miami; Edgardo Rodriguez of Homestead; Rodney Montoya of Miami; Dr. Santiago Bernabe Montoya of Miami, who worked in an allegedly fraudulent clinic; Jose Eloy Sanchez of Coral Gables; Abram J. Rodriguez of Miami, the HMO’s former marketing director; Mirna L. Blanco of Hialeah, who worked for both the HMO and two allegedly fraudulent clinics; Deborah Smith of Hialeah, an insurance agent at the HMO; andAugustin Abaga of Sunny Isles Beach, also an HMO insurance agent.

All of them have been arrested except for Zeron, Rodriguez and Sanchez, who are at large.

According to the Florida Office of Insurance Regulation, Florida Healthcare Plus had 9,948 Medicare enrollees and 537 Medicaid enrollees on June 30. The HMO generated $60.3 million in premiums in the first half of 2014 but lost $3.2 million.

The OIR order to suspend HMO said it didn’t maintain an adequate capital surplus and it had accounting errors.

Category: DR News |

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Last updated October 24, 2016 at 6:05 PM
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