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Miami Hospital Executive, Nine Others Charged in $1.4 Billion Rural Hospital Billing Scheme in Florida

adhy-savala-zbpgmGe27p8-unsplash-300x18810 people from Florida and elsewhere are accused of submitting $1.4 billion in fraudulent bills to insurance providers through rural hospitals, federal prosecutors announced Monday.

The indictment charges Jorge A. Perez, 60, of Miami-Dade, FL, and nine other defendants with health care fraud for allegedly exploiting federal regulations that allow some rural hospitals to charge significantly steeper rates for laboratory testing. The nine others named in the indictment are:

  • Seth Guterman, 54, of Chicago, IL
  • Ricardo Perez, 57, of Miami-Dade County, Fl
  • Aaron Durall, 48, of Broward County, FL
  • Neisha Zaffuto, 44, of Broward County, FL
  • Christian Fletcher, 34, of Atlanta, GA
  • James Porter Jr., 49, of Marion County, FL
  • Sean Porter, 52, of Citrus County, FL
  • Aaron Alonzo, 44, of Miami-Dade County, FL
  • Nestor Rojas, 45, of Miami-Dade County, FL

According to the indictment filed in the U.S. District Court in Jacksonville, the defendants allegedly bilked Florida Blue and other private insurance companies out of $1.4 billion to process urine and blood tests for patients who never set foot in their hospitals. Through the alleged fraud scheme, the defendants were purportedly able to obtain $400 million in reimbursements because the hospitals they used qualified for higher insurance payments.

“This was allegedly a massive, multi-state scheme to use small, rural hospitals as a hub for millions of dollars in fraudulent billings of private insurers,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The charges announced today make clear that the department is committed to dismantling fraud schemes that target our health care system, however complex or elaborate.”

The indictment claims the Miami hospital executive and some of the other defendants took over multiple struggling rural hospitals that had contractually negotiated higher reimbursement rates with private insurers for tests that were billed through outside labs. The rural hospitals involved in the alleged scheme are:

  • Cambellton-Graceville Hospital in Graceville, FL
  • Regional General Hospital in Williston, FL
  • Chestatee Regional Hospital in Dahlonega, GA
  • Putnam County Memorial Hospital in Unionville, MI

The hospital executive and his co-conspirators reportedly used the hospitals as a shell to fraudulently bill insurers for tests that were often not medically necessary. They obtained the samples for testing by paying kickbacks to recruiters from substance abuse treatment centers and sober homes.

Many of the hospitals they managed have since shut down as they ran out of money when insurance providers refused to pay for the fraudulent billing. Half of the rural hospital bankruptcies filed in the U.S. in 2019 were affiliated with the defendants’ enterprise, sources indicate.

“Trust and integrity undergird the confidence and reliability in our healthcare system,” said U.S. Attorney Maria Chapa Lopez for the Middle District of Florida. “Fraudulent and deceptive business practices undermine those values and erode the public’s trust in the system. We will continue to pursue those who set these tenets aside and compromise the care and safety of our citizens for profit.”

Billing fraud is the most common form of health care fraud. Anyone charged with this offense should immediately consult an experienced fraud defense attorney who can review the case and tailor a winning defense strategy.

South Florida Fraud Defense Attorney

Are you accused of committing health care fraud in South Florida? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 6.29.20 10 defendants charged in $1.4 billion rural hospital pass-through billing scheme.pdf

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