Osvaldo Garcia, owner of Universal Medical & Therapy Clinic; Osmani Gonzalez, owner of ABC Therapy; and two clinic office managers, Ailyn Cuervo and Daymi Crespo, were arrested in Miami, Florida earlier this week for their alleged involvement in a healthcare insurance scam that reportedly defrauded $2.7 million from the Miami-Dade school district.
All four face charges for health care fraud. Garcia, was formally charged yesterday, and Gonzalez are scheduled to be arraigned next week. Cuervo and Crespo have been released from jail to await trial at an unspecified date. The press did not specify an attorney for any of the defendants.
According to the arrest report, the investigation began when three unidentified employees of Felix Varela High School agreed to show up at Garcia’s ABC Therapy with their health insurance cards and driver’s licenses to fill out some blank forms in exchange for payment. Police say ABC Therapy allegedly billed Cigna Insurance Company for healthcare services that were never provided using the three school employees’ insurance information.
Investigators further claim Garcia’s and Gonzalez’s clinics collectively billed almost $13 million to the Miami-Dade school district, and that the two men purportedly collected $2.7 million from the scam. One of the clinics reportedly made over 100 fraudulent claims for medical services that were never provided. Investigators believe that the group managed to lure several other district employees to give their personal information in exchange for cash.
Authorities have named Raymir Rodriguez, whose nickname is reportedly “Papitas,” in the arrest warrant as the recruiter who found district employees willing to give away their insurance information. Rodriguez has yet to be charged and none of the school employees were arrested.
A similar health care fraud case was reported in Miami less than two weeks. It involved Philip Esformes, Odette Barcha, and Arnaldo Carmouze of Miami, Florida. The three were arrested for their involvement in what has been called the “largest single criminal health-care fraud case to ever be brought against individuals.”
Esformes and his co-conspirators allegedly started a fraud scheme that has reportedly cost the U.S. government $1 billion since 2009. Esformes, 47, is the owner of 30 nursing facilities in Miami. He and Barcha are being charged with conspiracy, health care fraud, money laundering, and obstruction of justice. Carmouze is only facing the first three charges.
The trio purportedly defrauded Medicare and Medicaid of almost a billion dollars by providing patients in Esformes’ nursing facilities with unnecessary medical services. They also allegedly gave patients narcotics so they would remain in his facilities, allowing the alleged fraud to continue.
Esformes faces life imprisonment under federal sentencing guidelines. He and Barch were scheduled to appear for a detention hearing on August 1, while Carmouze was scheduled for a hearing on August 3.