Clinic facilities

South Florida healthcare clinic owners, doctor and others convicted in medical billing fraud scheme | USAO-SDFL

Miami, Florida – Yesterday a federal district judge in Miami convicted the last of 10 defendants for his role in a health care fraud scheme involving three physical therapy clinics that recruited and paid bribes to beneficiaries of Blue Cross Blue Shield (BCBS) health benefit programs and submitted false claims to BCBS for services that clinics never provided to beneficiaries or that were not medically necessary.

The three South Florida clinics involved in the scam were Life Blue Medical Center, Corp. (“Blue Life”), Blue Life Medical Center, LLC (“Blue Life”) and Miami Medical Therapy (“Miami Medical”). The defendants, all South Florida residents now convicted and sentenced, include clinic owners, a doctor, patient recruiters, a physical therapist assistant and an office worker.

The conspiracy resulted in more than $17 million in misrepresentations being billed to BCBS, of which BCBS paid nearly $5 million. Most of the complaints related to unnecessary or never provided electrical stimulation, ultrasound therapies, therapeutic exercises and other physiotherapy procedures, as well as allergy testing and durable medical equipment. The conspirators spent the money they received from BCBS on personal items and to further the fraud.

Each defendant previously pleaded guilty to one count of conspiracy to commit health care fraud. United States District Judge K. Michael Moore sentenced the defendants as follows:

  • Jorge Gonzalez Perez, 57, (owner of Life Blue and Blue Life clinics) was sentenced to 120 months in prison, followed by three years of probation, and ordered to pay $4,143,892.16 in restitution;
  • Orlando Leiva, 66, (a physician with Life Blue and Miami Medical) was sentenced to 57 months in prison, followed by three years of supervised release, and ordered to pay $2,867,770.57 in restitution;
  • David Vladimir Sacerio, 30 (co-owner of Miami Medical) was sentenced to 51 months in prison, followed by three years of probation, and ordered to pay $686,086.33 in restitution;
  • Kiamy Perez, 36 (co-owner of Miami Medical) was sentenced to 34 months in prison, followed by three years of probation, and ordered to pay $686,086.33 in restitution;
  • Enry Guzman, 43, (patient recruiter) was sentenced to 33 months in prison, followed by three years of probation, and ordered to pay $228,075.73 in restitution;
  • Kyrenia Maquiera Rodriguez, 40 (physiotherapy assistant) was sentenced to 30 months in prison, followed by three years of probation, three years of probation, and ordered to pay $686,086.33 in restitution;
  • Freymil Lozada, 34, (patient recruiter) was sentenced to 27 months in prison, followed by three years of probation, and ordered to pay $184,393.52 in restitution; and
  • Haniel Rodriguez, 45, (patient recruiter) was sentenced to 24 months in prison, followed by three years of probation, and ordered to pay $198,540.57 in restitution.

Two defendants were ordered to pay compensation: Brian McIntosh, 53 (patient recruiter) in the amount of $119,174.66, and Melissa Cruz, 21 (Miami Medical office worker) in the amount of $686,086.33.

Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, and George L. Piro, Special Agent in Charge of the FBI Miami, made the announcement.

The Miami FBI investigated the case. Assistant US Attorney Shannon Shaw prosecuted the case. Assistant United States Attorney Annika Miranda is handling the asset forfeiture.

Court documents and related information can be found on the District Court for the Southern District of Florida website at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.govunder file number 21-cr-20376.

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