Feds bust Miami-Dade ring in $130 million healthcare fraud case

The city of Miami, Miami-Dade County public schools and several companies lost millions of dollars in health insurance payments as a result of being scammed by crooked clinics that submitted bogus claims for pain injections, according to newly filed indictments.
 
Federal agents arrested 14 suspects Wednesday on charges of scheming to bilk more than $130 million from the public entities, private companies and major insurers, namely Blue Cross Blue Shield, United Healthcare and Cigna.
 
Four other suspects — including the accused ringleader, Reynaldo Castillo — were also charged but have not yet been apprehended. One of those, Danny Jacomino Bordon, who ran a Miami rehab clinic as well as a film production business called Ouija Studios, is expected to surrender to FBI agents on Thursday.
 
All together, the various entities and their insurers paid out about $15 million to the healthcare network, which operated about 35 clinics in Hialeah, Doral and Miami between 2012 and 2015, according to the indictments.
 
Among the bilked entities: Pepsi Co., Macy’s, RadioShack, BJ’s Wholesale Club, Lincoln Property Company, Nextera Energy and Southeast Frozen Foods Company.
 
Most of those, as well as the city of Miami and Miami-Dade school system, are self-insured with healthcare plans managed by the big insurers — so the fraudulent healthcare payments came directly out of their pockets.
 
Assistant U.S. Attorney Christopher Clark said that he will seek to detain almost all of the defendants because they are considered flight risks — possibly to Cuba. He is also seeking to recover millions of dollars paid out to the defendants and to seize at least five buildings that some purchased to house their clinics.
 
Their bond hearings and arraignments are scheduled for next Wednesday.
 
The case is unusual because typically the U.S. attorney’s office prosecutes healthcare fraud offenders who try to fleece the taxpayer-funded Medicare program.
 
But, according to the indictments, the clinics used familiar ploys to carry out the racket: stealing the names of employees to file false claims, paying kickbacks to patient recruiters,
and misappropriating the licensing information of physicians. Most of the claims were for injections to treat purported knee and back pain.
 
Almost all of the clinics — including 1st Class Medical Centers, A Woman Health Center and Absolute Rehabilitation Center — were owned and operated by Reynaldo Castillo, Hendris Castillo Morales, Lisbet Castillo Batista and Maite Garcia, according to the indictments.
 
Another defendant, Alejandro Biart, is accused of being a patient recruiter who accepted kickbacks from the co-conspirators in return for referring Cigna beneficiaries to their clinics.
 
Most of the rest of the defendants, in exchange for a fee, allowed their names to be used to incorporate the clinics, open bank accounts and cash checks received from Cigna, Blue Cross Blue Shield and United Healthcare, the indictments said.
 

Source: MiamiHerald

Read more here: http://www.miamiherald.com/news/local/crime/article13493816.html#storylink=cpy