Clinics accused of bilking Miami-Dade schools of $2.7 million

The offer came from a vending-machine refill man known as “Papitas,” or French Fries.

He told three employees at Felix Varela High that they could earn some quick cash by simply showing up at a medical clinic, showing their health insurance card, driver’s license and signing a few blank forms.

They did. And Miami-Dade Schools police say that ABC Therapy turned around and fraudulently billed Cigna insurance company for healthcare services that were never actually provided.

In all, investigators believe ABC and another clinic fraudulently billed some $13 million to the school district, actually collecting about $2.7 million. The school district contracts with Cigna to administer its healthcare insurance.

Authorities have arrested four people on allegations of insurance fraud, including the clinic founders. Osvaldo Garcia, the owner of Universal Medical & Therapy Clinic, will be formally charged Thursday in Miami-Dade circuit court. Osmani Gonzalez, the owner of ABC, is scheduled to be arraigned next week.

More arrests could be likely in the coming weeks.

Gonzalez’s lawyer declined comment on Tuesday. Garcia’s attorney could not immediately be reached for comment.

“Miami-Dade Schools Police is actively working with local, state and federal law enforcement officials in this ongoing, complex investigation. Since this remains an open case, we are limited from commenting any further.” the department’s chief, Ian A. Moffett, said in a statement.

The other two charged so far are Ailyn Cuervo, 30, and Daymi Crespo, 39, both clinic office managers. All four have been released from jail to await trial.

None of the school employees was arrested.

The recruiter known as Papitas, identified in an arrest warrant as Raymir Rodriguez, has yet to be charged.

The three Varela High employees were paid for their personal information, according to an arrest warrant by schools Det. Anthony Alonso. One of the clinics submitted more than 100 claims for medical services that were never provided, according to the warrant. Authorities believe numerous other district employees were also lured by the clinics.

“We will be demanding and exhausting all options to obtain full restitution. Swift investigative action by our insurance fraud task force should stand as a warning to anyone in our community who intends to steal from our children,” said schools spokeswoman Daisy Gonzalez-Diego.

Healthcare related fraud involving the Miami-Dade school district has led to several far-reaching investigations in recent years.

In 2008, over 30 Miami-Dade Schools employees were arrested in a large bust for using bogus prescriptions to buy the powerful painkiller OxyContin, and for filing false insurance claims. In August 2005, 29 people — including 22 district employees — were nabbed in the similar scam.

The cases, along with hundreds of others involving bogus clinics and undelivered services, have reinforced Miami-Dade’s reputation as the nation’s healthcare fraud capital.

This story was originally published August 3, 2016 at 12:24 PM with the headline "Clinics accused of bilking Miami-Dade schools of $2.7 million."