A whopping 14 individuals were arrested on Wednesday, March 11 in connection with a healthcare fraud scheme that scammed more than $130 million from major public companies, the city of Miami, and Miami-Dade County public schools. They are being accused of submitting false claims for pain injections to treat knee and back pain. The insurance companies that were defrauded mainly include major entities such as Blue Cross Blue Shield, United Healthcare and Cigna.
Most of the abovementioned companies and pubic entities offer their employees self-insured healthcare plans that are managed by major insurance companies. The alleged scheme involved stealing the names of employees to file false claims. They are also accused of paying kickbacks to patient recruiters and misappropriating the licensing information of physicians. The companies then issued payment, which went directly into the pockets of the scammers. Because many of them are self-insured, the payments came out of their own funds.
In addition, some of the defendants are accused of allowing their names to be used to register the clinics as legit businesses. They also assisted by opening bank accounts and accepting checks received from the healthcare insurance companies.
Of those charged, Reynaldo Castillo has been pinpointed as the ringleader of the operation. Bond hearings and arraignments will take place Wednesday, March 18.
Assistant U.S. Attorney Christopher Clark is seeking to not only recover the millions of dollars that were paid out in the false claims, but also to seize buildings that were purchased to house the alleged clinics. In addition, he has stated that he will be making an effort to detain most of the defendants because he believes they run the risk of fleeing the United States.
When a person is charged with fraud of any kind, it’s critical to be represented by a defense attorney who has experience in those types of cases. A good attorney will be honest with the client about what to expect. In addition, they will have an understanding of how the prosecutors think when working fraud cases. A person convicted of fraud should also seek an attorney will give them realistic legal advice whether they are charged with financial fraud, insurance fraud, or government fraud.
MiamiHerlad.com, “Feds bust Miami-Dade ring in $130 million healthcare fraud case,” Jay Weaver, 12 March 2015