MIAMI, FL – On Tuesday, May 10, 2022, a federal district judge in Miami sentenced the last of 10 defendants for her role in a health care fraud scheme involving three physical therapy clinics that recruited and paid kickbacks to beneficiaries of Blue Cross Blue Shield health benefit programs (BCBS) and submitted false claims to BCBS for services that the clinics never provided to the beneficiaries or were not medically necessary.
The three South Florida clinics involved in the scam were Life Blue Medical Center, Corp. (“Life Blue”), 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 employee.
The conspiracy resulted in more than $17 million in false claims being billed to BCBS, of which BCBS paid close to $5 million. Most of the claims were for unneeded or never-provided electrical stimulation, ultrasound therapy, therapeutic exercise, and other physical therapy procedures, as well as for allergy tests and durable medical equipment. The conspirators spent the money they received from BCBS on personal items and to further the fraud.
Each defendant previously pled 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 supervised release, and ordered to pay $4,143,892.16 in restitution;
- Orlando Leiva, 66, (a doctor at Life Blue and Miami Medical) was sentenced to 57 months in prison, followed by three years 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 supervised release, 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 supervised release, 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 supervised release, and ordered to pay $228,075.73 in restitution;
- Kyrenia Maquiera Rodriguez, 40, (physical therapy assistant) was sentenced to 30 months in prison, followed by three years supervised release three years supervised release, 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 supervised release, 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 supervised release, and ordered to pay $198,540.57 in restitution.
Two defendants were ordered to pay restitution: Brian McIntosh, 53, (patient recruiter) in the amount of $119,174.66, and Melissa Cruz, 21, (Miami Medical office employee) in the amount of $686,086.33.
Juan Antonio Gonzalez, U.S. Attorney for the Southern District of Florida, and George L. Piro, Special Agent in Charge, FBI Miami, made the announcement. FBI Miami investigated the case. Assistant U.S. Attorney Shannon Shaw prosecuted the case. Assistant U.S. Attorney Annika Miranda is handling asset forfeiture.
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