Among the thousands of people charged with Medicare fraud in Miami, only a handful would qualify as repeat offenders.
Meet one of them, Vicente Gonzalez Acosta. A decade ago, Gonzalez pleaded guilty to helping a Miami-based network of HIV-therapy clinics expand into the South as they billed $100 million to the taxpayer-funded program and collected $30 million in payments. But they actually provided no medical services at all.
Instead of going straight after serving five years in prison — about half his original sentence because he cooperated with the feds — Gonzalez jumped right back into the Medicare rackets, authorities say.
He went on to play a supporting role in another Miami-based ring that opened a Michigan chain of home healthcare agencies, which then submitted $80 million in bogus claims to Medicare and reaped $53 million — again, without providing services to a single patient, they say.
Gonzalez, 48, and seven other defendants have been charged with Medicare fraud and laundering the proceeds. They’re accused of recruiting Cubans to pose as “straw owners” of home healthcare agencies — along with dozens of shell companies and bank accounts — to hide the identities of the actual operators and the illicit money flowing to them. The organization controlled a total of 140 bank accounts, according to court papers.
This is not the first time such a scheme has been carried out in Miami, the nation’s reputed capital of Medicare fraud. Since 2007, about 2,500 defendants submitting $8.3 billion in false claims have been charged in South Florida — including numerous cases involving suspects and fugitives from Cuba. But the sheer volume of Medicare billing activity over such a short span of three years sets the Gonzalez case apart from scores of other healthcare fraud prosecutions in South Florida.
Six of the eight defendants, including Gonzalez, are being held without bail before trial because they are considered flight risks with extended family in Cuba and potential access to $44 million in unaccounted-for Medicare funds.
“Moreover, the scheme involved close coordination with individuals who moved to and from Cuba, a country that does not have an extradition treaty with the United States,” Magistrate Judge Alicia Otazo-Reyes wrote in a series of detention orders this summer. It also involved “directing those individuals to make themselves unavailable in the United States by remaining in Cuba after participating in the scheme.”
No prosecutors in the U.S. Attorney’s Office or agents with the FBI or Health and Human Services have ever accused the Cuban government of having a direct hand in Miami’s long-running Medicare scams. But the Gonzalez case reveals the ease with which Cuban immigrants can move back and forth between Cuba and Miami to participate in massive healthcare schemes aimed at the U.S. government.
Gonzalez’s defense attorney, Omar Johansson, was not available to comment for this article.
An indictment accuses Eduardo Rubal of leading a team of operators who incorporated three home healthcare agencies in Michigan — Care, Nu-Wave and Tri-County — and recruited and paid nominee owners to cover their tracks. Rubal’s defense attorney, Marc Seitles, declined to comment on his client’s role, as he and seven other defendants await trial in Miami federal court in February.
Another defendant, Alberto Orian Gonzalez-Delgado, was described as a key player in the scheme because of his skill in billing Medicare. Gonzalez-Delgado has a state criminal history as well. His lawyer, Ramon De La Cabada, declined to comment.
A separate criminal affidavit filed by the FBI reveals that investigators targeted Rubal’s ring with a confidential source who wore a wire recording numerous incriminating conversations. While the identity of the source is unknown, it is apparent from the affidavit that he was initially involved in the scheme and his name appeared on the incorporation papers as the owner of the home health agencies in Michigan and other businesses in Florida and Illinois. The source, who has family in Cuba, volunteered to help the feds in November 2018, according to the affidavit.
Gonzalez, also known as “Puro,” warned the FBI’s source that he would have to return to Cuba once the ring’s Medicare fraud activities ended in Michigan because federal agents would chase after him. Gonzalez, having been convicted of Medicare fraud in the past, knew how the feds conducted their investigations.
“First they’re going to check all your addresses,” Gonzalez said while being recorded by the confidential source. “All of your addresses, the one here in Michigan, the one in Miami, all of your addresses, they are going to go there first. When they see that those don’t exist, then they start going deeper. ... They start checking your credit cards to see the movements, this and that. That’s how they work.”
Gonzalez tried to assure the source that he wouldn’t have to stay in Cuba forever.
“You can leave Cuba and you can come back here,” Gonzalez told him. “It could be that you come, stay here for a year, it may be that nothing ever happens to you. But the day something does happen, they are going to hit you with quite a few years.”
The source responded: “Yeah, the ones they catch with this, they will hit us with a lot of years, right?”
“Remember that — they don’t lock you up for what you take out [of Medicare],” Gonzalez told him. “They lock you up for what you billed [to Medicare].” What Gonzalez meant was that anyone who gets caught will be punished for how much he bills to Medicare, not for what he’s paid.
FBI special agent Jamie Garman, a former federal prosecutor in South Florida, said in the affidavit that the members of Rubal’s organization primarily lived in Miami and directed their Medicare fraud scheme from Miami between October 2016 and May 2019.
Garman said that after the Miami-based ring bought the three home health agencies in Michigan, the members billed Medicare for services such as physical therapy that were not provided to home-bound patients and received 60 percent of their reimbursement claims. The members were able to defraud Medicare because they received the funds before they were “required to provide supporting documentation that would legitimize the claims,” she said.
“They then funnel that money paid by Medicare for services that were never provided through several layers of shell companies and bank accounts in an effort to launder the money before withdrawing it as cash, including at ATMs and at check cashing stores in Miami,” Garman wrote in the 64-page affidavit.
“When the group either withdraws all of the fraudulently obtained money or when authorities begin shutting down the accounts, the group requires the nominee owners to flee to Cuba,” she said.
“There, the group confiscates the nominee owners’ passports and pays a portion of the promised amount in an effort to ensure that the nominee owner is unavailable to provide [incriminating] information to law enforcement about this scheme, or to testify against the group profiting from the fraud.”
In addition to the FBI’s confidential source, the most prominent nominee owner charged in the case is Antonio Jimenez, a Cuban, who was arrested in July as he traveled through Texas on his way to Mexico and then Cuba. Gonzalez had recruited him.
Jimenez was listed as the owner of 10 shell companies in Florida and three others in Illinois, as well as the signatory on 10 corporate accounts and 20 personal accounts at 12 different banks, according to the affidavit. While he received kickbacks for his services, almost all of the Medicare money withdrawn from those accounts was handed over to the main members of Rubal’s ring.
“It’s unfortunate that repeat offenders like Gonzalez continue to victimize individuals like my client, Antonio Jimenez, and the American healthcare system,” said defense attorney Joel DeFabio, who has been involved in several Medicare fraud cases in Miami.
“What is also outrageous is the government’s utter failure to verify the home healthcare agencies’ bills prior to paying out millions of limited taxpayer dollars — only to see that money funneled to Cuba and not used for the care of our own citizens.”