Tag Archives: Healthcare fraud

Miami Couple Sentenced For Operating Clinic to Defraud Medicare

On June 29, 2015, U.S. District Judge Susan C. Bucklew sentenced Gladys Fuertes, 41, and Mario Fuertes, 41, of Miami for operating a sham clinic. Gladys Fuertes was sentenced to 19 years and 6 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, aggravated identity theft, and obstruction of healthcare fraud investigation. Mario Fuertes was sentenced to 11 years and 3 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, and obstruction of a healthcare fraud investigation. The couple was ordered to forfeit $1,036,759.72. A federal jury convicted the Fuerteses on March 24, 2015.

According to a Department of Justice release, the couple established and operated Gables Medical and Therapy Center for the purpose of committing healthcare fraud by employing unlicensed medical professionals. The Fuerteses misused the Medicare billing numbers of other medical professionals, without their knowledge, in order to claim medical treatments.

Prosecutors say Gladys and Mario Fuertes paid a co-conspirator to recruit Medicare beneficiaries and to drive patients to the Gables Medical for basic and sham medical services. The couple fraudulently billed Universal Medicare in excess of $900,000 for treatments not rendered and for treatments requiring a physician’s presence.

Gladys and Mario Fuertes also facilitated the provision of fraudulent prescriptions for controlled substances to Gables patients and allowed a co-conspirator to assist patients in filling prescriptions for controlled substances such as oxycodone, according to the Department of Justice. The co-conspirator also purchased the controlled substances from Gables patients and sold them on the street.

Gladys and Mario Fuertes also obstructed the federal investigation by instructing Gables Medical patients to lie to law enforcement agents. The couple provided federal agents with altered Medicare documentation.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,300 defendants who collectively billed the Medicare program for over $7 billion, according to a Department of Justice report.

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Filed under Insurance Fraud

“Operation Never Ends” Leads to Closure of Two Clinics, Multiple Arrests

“Operation Never Ends,” the multi-organizational investigation organized by Miami police, the Secret Service, local and state agencies and insurance companies, has led to the closure of two clinics involved in staging accidents and making fraudulent insurance claims.

The more than one year long operation led to the arrest of, among others, Jorge Felix Felipe Pupo, 49, accused of being the ringleader, and Yanaris Ramirez Paneque, 36, a receptionist at one health clinic, according to authorities.  According to the report from NBC 6:

Police say they went undercover inside a medical building in the 700 block of Northwest 23rd Avenue and at another location near Flagler and the Palmetto Expressway.

Detectives said recruiters would find those willing to participate in the staged accidents, then bring them to medical clinics where paperwork was done to get money back from insurance companies.

Police Sgt. Luis Taborda explained the scheme.

“The clinics are the main,” he said. “They provide the money to a runner and the runner puts together the crash — orchestrates the crash.”

Police said the ring was making big money on the claims.

“I could tell you that in one investigation that we did at the beginning, they were up to $80,000 before we shut them down — in just one crash,” Taborda said.

The article from NBC 6 South Florida is available here.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing