Little Havana’s Billing USA offered a comprehensive menu of services for its medical business clients, from basic billing to complete financial falsehoods that made multimillion-dollar healthcare fraud almost cut-and-paste easy.
Friday’s conviction of Billing USA office manager Francel Rodriguez on one count of conspiracy to commit healthcare fraud is only part of the story. Several other associates also will be offered a comprehensive menu of federal prison food over the next few years.
Billing USA’s owner Mauricio Palma, 45, is in the downtown Miami Federal Detention Center, a few months into his eight-year sentence after pleading guilty to conspiracy to commit healthcare fraud. Palma’s also hit with $2,110,173 in restitution and lost $1.8 million in forfeiture.
Also in the downtown Miami prison: 42-year-old Rafael Izquierdo-Rios of West Miami-Dade, who earned a sentence of six years and five months. Izquierdo-Rios helped run Billing USA and also used the scam at his own billing company, American Fast Services, to skin Blue Cross Blue Shield, Cigna and UnitedHealthcare for $2,278,702.
Sergio Carratala, 31, will find out on Sept. 14 how much jail time he will earn from his conspiracy to commit healthcare fraud. Rodriguez, 40, will receive his sentence Nov. 1.
Christopher Clark led the prosecutions.
In court documents, Carratala says he, Palma, Izquierdo-Rios and Blue Diamond Medical Center president Celia Dominguez-Cruz filed or helped file $5,692,102 of fraudulent claims to Blue Cross “that falsely and fraudulently represented that various health care benefits, primarily physical therapy and injectable drugs, were medically necessary, prescribed by a doctor, and had been provided by Blue Diamond” to Blue Cross customers.
Blue Cross paid $653,893 into the corporate account of Blue Diamond, a West Miami-Dade clinic. (And that’s why $653,893 is the restitution part of Dominguez-Cruz’s sentence for healthcare fraud. She was released June 13 after getting her two-year, four-month sentence reduced.)
Rodriguez, Palma and Izquierdo-Rios filed $5,943,053 in similar fake claims to Blue Cross and Cigna for benefits from Salvus, a Little Havana medical clinic. Blue Cross poured $1,638,378 into Salvus’ corporate account.
Billing USA received a percentage of the fraud funds.
As explained by the Department of Justice in an emaill, “In some cases, clinics provided Billing USA with completed super-bills, which specified what they wanted to have billed on their behalf. Billing USA would transcribe the super-bill into the official documents accepted by the insurance companies. Billing USA charged a six percent fee of whatever the insurance companies paid for the claims for this option.”
But, Billing USA showed a knack for service, going that extra white collar criminal mile for its customers.
For other customers, Justice explained, Billing USA “offered to fabricate the super-bill entirely for the clinics. In these scenarios, clinics would only have to submit patient information to Billing USA, and employees would fabricate a super-bill, bill the insurance companies for whatever the patient’s insurance plan would allow, and then inform the clinic of what they had billed so the clinic in turn could fabricate patient files to reflect the same.”