Courts

Westchester pain clinic managers are accused in fake claim scam

 

dovalle@MiamiHerald.com

In one case, a former Miami-Dade county bus driver allowed AZJ Medical Center to bill for 135 visits and 758 treatments, police say, even though all she got was a handful of massages.

Another transit employee driver signed many blank medical forms, allowing the pain clinic to bill for more than 30 bogus visits and hundreds of phantom treatments.

The Westchester clinic, in one case, floated the false claim to an insurance company that one bus driver got hurt — by banging her elbow on a towel holder, police say.

The stories were included in an arrest warrant released Tuesday in a Miami-Dade police crackdown on the clinic’s operators.

The Miami-Dade Police public corruption bureau announced it had arrested six people who ran the clinic at 7483 SW 24th St. Investigators say the clinic recruited transit workers to file bogus claims with AvMed Inc., which administers the county’s self-funded health insurance program.

The company’s president, Elvis Garcia, was not immediately arrested, and was considered a fugitive.

Those arrested: Juan Carlos Avila, the company’s original president; staffers Caridad Menendez Diaz and Aracelys Cruz; physical therapy assistant Hector Gutierrez; and occupational therapist Ovide Miguez.

They were charged with a host of felonies, including organized scheme to defraud, filing false insurance claims, grant theft and patient-brokering. In all, Miami-Dade police say, the clinic billed the county for at least $129,000 in bogus claims.

The arrests of the upper ranks of the clinic comes one year after Miami-Dade police and prosecutors arrested seven transit bus employees for their role in the scheme.

Six of those pleaded guilty and agreed to cooperate against the ringleaders, according to a warrant by Miami-Dade Detective Dennis Delgado and prosecutor Sandra Miller-Batiste.

The investigation began when a cooperating source told authorities that Nancy Maradey, a bus driver, had approached the source asking for participation in the scheme.

Maradey later told detectives that Garcia paid her more than $6,000 cash to use her name to file claims for phantom treatments, and to recruit other fake patients. Medical records showed that the clinic billed for extensive treatments on Maradey’s sprained knee even though the woman told police she never got any treatment for the condition.

As for Gutierrez, the therapy assistant, he told investigators that Avila and Diaz gave him $45 for each “progress” form he signed for clients that he never actually treated. Miguez, the therapist, also signed “progress” forms for patients seen by a massage therapist, Kelpa Hernandez, masquerading as an occupational therapist, the warrant said.

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