A $13.9 million fraud scheme involving a network of medical clinics resulted in the arrest of 14 Miami-Dade County residents on March 11, according to the U.S. Attorney’s Office for the Southern District of Florida.
As readers of the FLPIPGuide.com know, our coverage of medical clinics typically relates to PIP fraud. In this case, however, the named medical clinics allegedly intended to defraud health care insurers and employer-sponsored plans.
The following individuals were charged with health care fraud and conspiracy to commit health care fraud in the case of United States v. Reyna/do Castillo, et al.:
- Reynaldo Castillo, 46, Hialeah
- Hendris Castillo Morales, 33, Miami
- Lisbet Castillo, 23, Hialeah
- Maite Garcia, 40, Hialeah
- Osvaldo Marin Medina, 48, Hialeah
- Alejandro Biart, 40, Miami
- Alejandro Jesus Cura, 47, Miami
- Dania Chavez, 43, Miami
- Ezequiel Severo Casas, 28, Hialeah
- Humberto Martinez Rodriguez, 43, Hialeah
- Jose Gerardo Gonzalez, 23, Miami
- Julio Suarez, 47, Miami
- Nelson Ramos, 56, Miami
- Reinaldo Cinta Gonzalez, 46, Miami
- Rudy N. Dominguez, 25, Hialeah
- Diulys Martinez, 39, Miami
As many as 30 medical clinics based in Miami, Hialeah, Hialeah Lakes, and Doral, Fla. were owned or controlled by Reynaldo Castillo, Hendris Castillo Morales, Lisbet Castillo Batista, and Maite Garcia, according to the indictment.
Physician names and licensing information obtained through medical staffing companies was allegedly misappropriated to conceal the actual clinic ownership. Additionally, some of the individuals charged were paid fees in exchange for the use of their names as fronts for corporate ownership, bank accounts, and check cashing privileges.
Insurance companies Cigna, Blue Cross Blue Shield (BCBS), and United Health Care (UHC) were affected by the scam. Several self-insured employers whose insurance plans were managed by the three carriers were also the target of fraud, including:
- Miami-Dade Public Schools
- City of Miami
- Pepsi Co.
- BJ’s Wholesale Club
- Nextera Energy
False and fraudulent claims totaling $125.7 million were submitted to the insurance carriers and employer plans, of which $13.85 million was paid. Many of the claims were for treatments that were not ordered by a physician or services that were never delivered.
The indictment also alleges that Reynaldo Castillo, Lisbet Castillo Batista, and Hendris Castillo incorporated an investment company to receive proceeds from the clinics and used those proceeds to purchase real estate properties. Those properties are subject to criminal forfeiture.
In a companion case, United States v. Ernesto Castillo, Osvaldo Marin Medina, Alejandro Biart, Ernesto Castillo, 43, of Hialeah, and Danny Jacomino Bordon, 50, of Miami were charged with health care fraud for causing Amazing Medical Services, Inc., Serenity Rehabilitation Center, Inc., and World of Rehabilitation Therapy, Inc. to submit false claims to Cigna totaling approximately $5.1 million, which resulted in payments to the three companies of approximately $1.1 million.
Jose Gerardo Gonzalez, Reynaldo Castillo, Ezequiel Severo Casas, and Danny Jacomino Bordon remain at large.
Click on the link to read the news release issued by the U.S. Attorney’s Office for the Southern District of Florida.