Owners and employees of clinics in Miami are accused of misappropriating $308 million from the healthcare system

More than 50 employees, executives, and owners of clinics and medical centers in South Florida have been accused of defrauding health care programs of approximately $308 million, federal authorities announced this Friday.

According to a report from the federal prosecutor's office in Miami, over the past six weeks, criminal charges have been brought against individuals involved in fraudulent activities against the healthcare system, following a nationwide coordinated law enforcement action to combat the rising wave of violations in the medical sector.

The federal charges brought against the defendants cover a wide range of criminal schemes, from the theft of personal protective equipment related to the fight against COVID-19 and fraud in specialized drug treatment centers, to more common offenses against Medicare and Medicaid programs, embezzlement from medical equipment providers, violations in pharmaceutical services, bribery, and money laundering.

It is alleged that those involved in the scam in the South Florida district, which stretches from Palm Beach to the Florida Keys, managed to collect over $106 million out of the $308 million billed in fraudulent claims over a period of six weeks.

The raid included several clinics, hospitals, and companies in the Miami area, Miami Beach, Hialeah, and Hialeah Gardens, and among those charged are numerous individuals of Cuban descent, according to CiberCuba.

"South Florida is Ground Zero for health fraud and, as a result, the FBI and associated agencies devote vast resources to investigating, catching, and prosecuting those who commit this fraud," stated George L. Piro, special agent of the FBI in Miami. "The victims are American taxpayers, you and I, and our message to those who commit healthcare fraud and steal from American taxpayers is clear: they will be caught and they will be punished."

The investigation conducted in South Florida involved the FBI, the Department of Health and Human Services, the Office of Inspector General (HHS-OIG), the Social Security Administration, the Investigations Unit of the Department of Homeland Security (HSI), and the Insurance Fraud Department, among other state and federal agencies.

Among the cases and individuals processed are the following:

• Rickey Delancey, de 30 años y residente de Miami. Acusado de conspiración para robar productos médicos, robo de productos médicos y transporte de bienes robados. Delancey trabajaba en el departamento de suministros del Hospital Mount Sinai, en Miami Beach, y entre abril y noviembre de 2020 robó N95 masks y otros suministros médicos para venderlos a varios compradores. Vendió en total $55,000 dólares en máscaras robadas a un comprador de California. Como resultado de los robos, durante el punto álgido de la pandemia de COVID-19, el Mount Sinai no disponía de los suministros necesarios para las enfermeras, los médicos, el personal y los pacientes.
• Edward Pizzi, 40 years old and a resident of Miami. Owner of Ríos Medical Center and Unión Medical Clinic, both in Miami. Accused of conspiracy to pay healthcare bribes. He instructed his employees to offer bribes to recruit Medicare and Medicaid beneficiaries at the clinics, and to offer purported mental health services. Most of the recruited beneficiaries neither needed nor qualified for those services.
• Mayara González Chaviano, 28 years old and residing in Miami. Accused of conspiracy to pay healthcare bribes. She was the office manager of the Medical Center and the Unión Medical Clinic. She managed the clinics' scheme to pay bribes and recruit beneficiaries of Medicare and Medicaid.
• Liliana Liseth Duarte, 47 years old and residing in Miami. Employee of Ríos Medical Center and Unión Clinic. Accused of conspiracy to pay healthcare bribes.
• Greisy Rosario Varona Docasal, 52 years old and a resident of Miami. Office manager for a physician. Accused of conspiracy to illegally recruit Medicare beneficiaries and refer them to health agencies in exchange for receiving kickbacks.
• Mayra De La Paz, 69 years old and a resident of Hialeah. Accused of conspiracy to solicit and receive bribes from a home healthcare agency in connection with Medicare.
• Michael Marcelus Mogollón, 33 years old and a resident of Miami. Accused of conspiracy to commit healthcare fraud and wire fraud. Mogollón paid bribes to beneficiaries of the Blue Cross Blue Shield insurance in exchange for patients allowing Miami clinics Quality Professional and Renewal, and Zion Medical in Hialeah, to bill for benefits, items, and medical services that were not necessary. The clinics billed Blue Cross Blue Shield approximately $678,800 and collected $220,000 in false claims.
• Jorge Luis Taboada, 52 years old and a resident of Miami, is accused of conspiracy to commit healthcare fraud and wire fraud. He paid bribes to beneficiaries of Blue Cross Blue Shield and Aetna health insurance in exchange for allowing United Medical of South Florida to bill for medical benefits, items, and services that were unnecessary, ineligible for reimbursement, and not received by the beneficiaries. The clinics billed Blue Cross Blue Shield and Aetna between $1.5 and $3.5 million.
• Julio Cesar Betancourt, 31 years old and a resident of Hialeah Gardens. Owner of JD Solution USA. Accused of conspiracy to commit money laundering. Conspired to launder $363,139 in profits from healthcare fraud between July and October 2019.
• Jorge Luis López Peña, 36 years old and a resident of Miami. Owner of Lopez Distributors. Accused of conspiracy to commit money laundering. Conspired to launder $185,671 in healthcare fraud profits between August and December 2019.
• Ángel Pimentel, 72 years old and a resident of Miami. Owner of Maggie Pharmacy Discount in Hialeah. Accused of conspiracy to commit healthcare fraud. Between March 2015 and August 2019, he submitted $988,983 in claims to Medicare, falsely and fraudulently providing various healthcare benefits, primarily unnecessary medications.

"We will not relent in our efforts to hold accountable those in South Florida who exploit healthcare programs and the trust of patients for personal gain, especially during the global COVID-19 pandemic," said Juan Antonio González, chief of the federal prosecution in the Southern District of Florida.

The government offensive against fraud in the healthcare system has spread nationwide. While South Florida led in criminal cases, a total of 138 individuals were charged across the country, including 42 doctors, nurses, and other medical professionals for their alleged involvement in various schemes of forgery and fraud that resulted in approximately $1.4 billion in losses.

The largest volume of fraud -around $1.1 billion- is recorded in scams committed through telemedicine, a practice that became widespread during the pandemic to provide remote healthcare services using technology.

Southern Florida leads the nation in healthcare fraud trials. During the fiscal year 2021, which ends on September 30, a total of 196 individuals have been charged with crimes related to embezzlement from the healthcare system.

It is estimated that fraudulent activities in the medical sector involved billings of $2.2 billion, of which approximately $488 million were paid.