As Medicare rackets go, authorities say, this one had no borders.
Eleven people associated with a South Florida managed care company were charged Wednesday with fleecing Medicare for services provided to U.S. citizens while they were living in Nicaragua and the Dominican Republic, according to an indictment.
Coral Gables-based Florida Healthcare Plus filed false bills for retired Medicare beneficiaries who claimed to be living in the state but were being treated by foreign doctors while they resided in the two Latin American countries. That is illegal under the federal taxpayer-funded program for senior citizens and the disabled, authorities said.
Eight of the defendants, including a physician, were arrested Wednesday. The remaining three offenders are in Nicaragua.
The defendants are accused of defrauding Medicare and the parallel state Medicaid program for low-income people.
All together, the defendants raked in $25 million in the transnational fraud scheme between 2011 and 2014, Assistant U.S. Attorney Eric Morales said. The investigation, led by the FBI and Health and Human Services’ Office of Inspector General, is believed to be the first of its kind in South Florida, the nation’s capital of healthcare fraud, and in the United States.
“Unfortunately, scams that bilk our healthcare system do not stop at our borders,” said George Piro, special agent in charge of the FBI in Miami.
“Providing Medicare services in foreign countries but billing as if they occurred in the United States is in-your-face fraud,” said Derrick Jackson, special agent in charge of HHS-OIG’s office in Florida.
Florida Healthcare Plus, which operates under the program’s Medicare Advantage plan, did not return calls for comment. Six of its employees — including Pedro Hernandez of Miramar, the former chief operating officer — were among the defendants charged with Medicare fraud.
Also charged: Dr. Santiago B. Montoya of Miami, who owned a business, Integrated Health Medical Center, which contracted with Florida Healthcare Plus to provide services; and Montoya’s son, Rodney, who also contracted with the managed care company.
Florida Healthcare Plus and its contractors allegedly promoted the program to so-called expatriates in Nicaragua and the Dominican Republic, including recruiting retired Americans and native Nicaraguans who had fled their homeland for the U.S. during a civil war.
The managed care company flew the participants to Miami to evaluate them for its Medicare Advantage plan, prosecutors said. After the beneficiaries established phony addresses in Florida, they were enrolled in Medicare and Medicaid plans. Then, they returned to the Latin American countries and Florida Healthcare Plus and its contractors allegedly billed Medicare for various patient services, they said.
Prosecutors said that Florida Healthcare Plus and its contractors deliberately misled the ex-patriates to exploit them for swindling Medicare.
“To induce individuals to enroll in [Medicare Advantage] plans, the defendants initially represented that Medicare benefits were available in Nicaragua and the Dominican Republic,” according to an indictment.
“When questions about Medicare coverage outside the United States were raised, the defendants made false and fraudulent representations, including that ‘people retired in the U.S. now in Nicaragua can get free medical care,’ and that medical coverage offered in Nicaragua and the Dominican Republic was not offered by, or billed to, Medicare,” the indictment stated.
Five of the defendants — Rodney Montoya, Abram J. Rodriguez, Mirna L. Blanco, Deborah Smith and Augustin Abaga — had their first appearances in Miami federal court Wednesday afternoon before Magistrate Judge Patrick White. Three more defendants — Dr. Santiago Bernabe Montoya, Freddy S. Zeron and Pedro Hernandez — are scheduled to appear in court Thursday.
All are awaiting arraignments and bond hearings.