Owners of health clinics in South Florida, employees convicted of roles in multiple fraud schemes | USAO-SDFL

Miami, Florida – A federal district judge in Miami has convicted the last of five defendants for his role in a health fraud scheme run by a physiotherapy clinic in Doral.

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

The five defendants were convicted as follows:

  • Carlos Rafael Saez Dorta, 42, (owner of a clinic) was sentenced to 135 months in prison after a trial, three years of controlled release, and was sentenced to pay $ 4,434,069 in restitution;
  • Veronica Ramos Hernandez, 35, (clinic owner) was sentenced to 135 months in prison after a trial, three years of supervised release and sentenced to pay $ 4,434,069 in restitution;
  • Michael Burroughs, 43, (patient recruiter) was sentenced to 46 months in prison after a guilty plea, three years of controlled release and sentenced to pay $ 73,116.61 in restitution;
  • Dianelis Garcia Alvarez, 41, (office manager) was sentenced to 35 months in prison after pleading guilty, three years of controlled release, and was sentenced to pay $ 357,256 in restitution; and
  • Deandre Mitchell Gabriel, 33, (patient recruiter) was sentenced to 24 months in prison after a guilty plea, three years of controlled release, and was sentenced to pay $ 30,810 in restitution;

Juan Antonio Gonzalez, the United States Attorney for the Southern District of Florida, and George L. Piro, a special agent in charge of the FBI, a field office in Miami, made the announcement.

According to evidence presented in court, the conspiracy to invoice fraud has led to more than $ 8 million in false claims filed with BCBS. Most of the claims are for unnecessary or never provided physiotherapy treatments, such as electrical stimulation, ultrasound therapy and therapeutic exercises, as well as for long-term medical equipment.

In addition, evidence shows that in 2021, clinic owners (Saez and Ramos) applied for a $ 607,585 loan for the Wage Protection Program (PPP), as well as a $ 500,000 loan for economic disaster damage. (EIDL) from the Small Business Administration (SBA). As a result, Saez and Ramos received more than $ 1 million through these COVID-19 relief programs by stealing money destined for legitimate small businesses suffering from the devastating effects of the COVID-19 pandemic.

The FBI in Miami is investigating the case. Assistant Attorney General Shannon Shaw and Stephanie Hauser for the South District of Florida were prosecuting the case. Assistant Attorney General Anika Miranda was involved in asset forfeiture.

The Coronavirus Aid, Aid and Economic Security Act (CARES) is a federal law designed to provide emergency financial assistance to millions of Americans who have 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 repayable small business loans to save jobs and some other costs through PPPs. The CARES Act also authorized and provided funding to the SBA to provide EIDL to eligible small businesses, including sole traders and independent contractors experiencing significant financial disruption due to the COVID-19 pandemic, to enable them to meet financial obligations and operating costs. which could otherwise have been met if the disaster had not occurred. EIDL applications were submitted directly to the SBA through the SBA’s online application website and applications were processed and loans were funded for eligible applicants directly from the SBA.

On May 17, 2021, the Attorney General established the COVID-19 Anti-Fraud Task Force to manage the resources of the Department of Justice in partnership with agencies across the government to step up efforts to combat and prevent pandemic-related fraud. The working group is stepping up its efforts to investigate and prosecute the most guilty local and international criminals and assists the agencies in charge of administering fraud prevention assistance programs by, inter alia, expanding and incorporating existing coordination, identification and identification mechanisms. of resources and techniques for detecting fraudsters and their schemes, as well as sharing and using information and insights gained from previous enforcement efforts. For more information on the Pandemic response, please visit https://www.justice.gov/coronavirus.

Anyone with information on allegations of attempted fraud related to COVID-19 can report this by calling the Justice Department’s National Disaster Fraud Center (NCDF) hotline at 866-720-5721 or via the NCDF’s web complaint form at: https: // www. .justice.gov/ disaster-fraud / ncdf-disaster-complaint-form.

Related court documents and information can be found on the South Florida District Court website at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.gov, case number 21-cr- 20324.

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