South Florida health clinic owners, doctor, others convicted of medical billing fraud – The Published Reporter®

The conspiracy resulted in more than $17 million in false claims being billed to BCBS, of which BCBS paid nearly $5 million. File Photo: Dzelat, Shutter Stock, Licensed.

MIAMI, FL — On Tuesday, May 10, 2022, a federal district judge in Miami convicted the last of 10 defendants for her role in a health care fraud scheme involving three physical therapy clinics that recruited and paid bribes to beneficiaries of Blue Cross Blue Shield health benefit programs (BCBS). ) and made false claims to BCBS for services that the clinics never provided to beneficiaries or that were not medically necessary.

The three South Florida clinics involved in the scam were Life Blue Medical Center, Corp. (“Life Blue”), Blue Life Medical Center, LLC (“Blue Life”) and Miami Medical Therapy (“Miami Medical”). The defendants, all South Florida residents now convicted and convicted, include clinic owners, a physician, patient recruiters, a physical therapist assistant, and an office worker.

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The conspiracy resulted in more than $17 million in false claims being billed to BCBS, of which BCBS paid nearly $5 million. Most of the claims related to unnecessary or never provided electrical stimulation, ultrasound therapy, therapeutic exercises and other physical therapy procedures, as well as allergy testing and durable medical equipment. The conspirators spent the money they received from BCBS on personal items and to further the fraud.

Each defendant previously pleaded guilty to one count of conspiracy to commit health care fraud. U.S. District Judge K. Michael Moore sentenced the defendants as follows:

  • Jorge Gonzalez Perez, 57, (owner of the Life Blue and Blue Life clinics) was sentenced to 120 months in prison, followed by three years of supervised release, and ordered to pay $4,143,892.16 in restitution;
  • Orlando Leiva, 66, (a physician at Life Blue and Miami Medical) was sentenced to 57 months in prison, followed by three years of supervised release, and ordered to pay $2,867,770.57 in restitution;
  • David Vladimir Sacerio, 30, (co-owner of Miami Medical) was sentenced to 51 months in prison, followed by three years of supervised release, and ordered to pay $686,086.33 in restitution;
  • Kiamy Perez, 36, (co-owner of Miami Medical) was sentenced to 34 months in prison, followed by three years of supervised release, and ordered to pay $686,086.33 in restitution;
  • Enry Guzman, 43, (patient recruiter) was sentenced to 33 months in prison, followed by three years of supervised release, and ordered to pay $228,075.73 in restitution;
  • Kyrenia Maquiera Rodriguez, 40, (physiotherapy assistant) was sentenced to 30 months in prison, followed by three years of supervised release, three years of supervised release, and ordered to pay $686,086.33 in restitution;
  • Freymil Lozada, 34, (patient recruiter) was sentenced to 27 months in prison, followed by three years of supervised release, and ordered to pay $184,393.52 in restitution; and
  • Haniel Rodriguez, 45, (patient recruiter) was sentenced to 24 months in prison, followed by three years of supervised release, and ordered to pay $198,540.57 in restitution.

Two defendants were ordered to pay restitution: Brian McIntosh, 53, (patient recruiter) in the amount of $119,174.66, and Melissa Cruz, 21, (Miami Medical office worker) in the amount of $686,086.33.

Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida, and George L. Piro, FBI Miami Special Agent in Charge, made the announcement. FBI Miami is investigating the case. US Assistant Attorney Shannon Shaw has prosecuted the case. US Assistant Attorney Annika Miranda is handling the asset forfeiture.

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