Owners, Employees Sentenced for Roles in Fraud Schemes

South Florida Health Care Clinic Owners, Employees Sentenced for Roles in Multiple Fraud Schemes

A federal district judge in Miami sentenced the last of five defendants for his role in a health care fraud scheme operated out of a physical therapy clinic in Doral.

According to court records, the defendants recruited and paid off beneficiaries of Blue Cross Blue Shield (BCBS) health insurance plans, then billed BCBS for services the clinic either never provided or which were not medically necessary. The two clinic owners also used the business, Polyclinic Healthcare Corp., to fraudulently obtain COVID-19 relief funds.

The five defendants were sentenced as follows:

Carlos Rafael Saez Dorta, age 42, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
Veronica Ramos Hernandez, age 35, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
Michael Burrowes, age 43, (patient recruiter) was sentenced to 46 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $73,116.61 in restitution;
Dianelis Garcia Alvarez, age 41, (office manager) was sentenced to 35 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $357,256 in restitution; and
Deandre Mitchell Gabriel, age 33, (patient recruiter) was sentenced to 24 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $30,810 in restitution;
Juan Antonio Gonzalez, United States Attorney for the Southern District of Florida, and George L. Piro, Special Agent in Charge, FBI, Miami Field Office, made the announcement.

According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS. Most of the claims were for unneeded or never-provided physical therapy treatments, such as electrical stimulation, ultrasound therapy, and therapeutic exercise, as well as for durable medical equipment.

Additionally, the evidence showed that in 2021 the clinic owners (Saez and Ramos) applied for a $607,585 Paycheck Protection Program (PPP) loan as well as a $500,000 Economic Injury Disaster Loan (EIDL) from the U.S. Small Business Administration (SBA). As a result, Saez and Ramos received over $1 million through these COVID-19 relief programs, stealing money that was meant for legitimate small businesses suffering from the devastating effects of the COVID-19 pandemic.

FBI Miami investigated the case. Assistant U.S. Attorneys Shannon Shaw and Stephanie Hauser for the Southern District of Florida prosecuted the case. Assistant U.S. Attorney Annika Miranda handled asset forfeiture.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act is a federal law designed to provide emergency financial assistance to millions of Americans who suffered financially from the COVID-19 pandemic. One source of relief provided by the CARES Act was the authorization of hundreds of billions of dollars in forgivable loans to small businesses for job retention and certain other expenses through the PPP.

The CARES Act also authorized and provided funding to the SBA to provide EIDLs to eligible small businesses, including sole proprietorships and independent contractors, experiencing substantial financial disruptions due to the COVID-19 pandemic to allow them to meet financial obligations and operating expenses that could otherwise have been met had the disaster not occurred. EIDL applications were submitted directly to the SBA via the SBA’s on-line application website, and the applications were processed and the loans funded for qualifying applicants directly by the SBA.

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud.

The Task Force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts.

SOURCE: USDOJ.Today