Five employees of a dental management company wereaccused of defraudingto insurance formore than a million dollars through dental clinics in Hialeah and Little Havana.
Mercedes Linares, 53 years old;Christ Olson, 47;Leonardo Ramos, 22;Leonel Ravelo, 34 andRyon Vazquez, 33, were arrested Tuesday on charges including filing false insurance claims, organized scheme to defraud and criminal use of personal information, according to arrest reports, to which he had accessLocal 10 News.
The five -four of them of Cuban origin- allegedly participated in a $1.3 million insurance fraud scheme at two dental clinics in South Florida.
The suspects would have used IDs of dentists who no longer worked in their clinics to bill insurance and added unnecessary procedures to collect extra bonuses.
According to the police report, in 2020, a couple sold the shares of their dental clinic, with offices located in Hialeah and the Little Havana neighborhood of Miami, to the management company made up of the five involved.
The company later fired the couple and allegedly implemented operations that violated Florida statutes related to non-dentist ownership of dental clinics.
Authorities said the company continued billing insurance companies for procedures using IDs of dentists who no longer worked there.
The suspects also asked six associate dentists to "will accept a new billing process" in which procedures performed by dental assistants "would be signed off by existing credentialed physicians even though they did not administer or supervise the treatments."
However, the dentists took issue with this process because they did not supervise, would not be compensated and did not want their licenses to be used without their direct management, the police report stated.
Authorities also revealed that Leonel Ravelo led the manager of the Little Havana office to use something called a "behavior management code" on all children under the age of six "without the knowledge and consent of doctors, to increase production." and meet your financial goals for a monetary bonus."
The six dentists discovered this scheme to defraud including claims for services not provided and stopped billing, the report added, and conducted an audit of all "behavioral management code" claims.
Their audit revealed 50 fraudulent claims, four of which had already been filed, totaling $1,800 in fraud.
"Material evidence, witness affidavits and financial records will demonstrate that Olson, Vazquez and Ravelo knew and conspired to correct and cover up this fraud after (the dentists) confronted them," the note stated.
The total amount of the fraud amounted to $1,350,246, according to authorities.
Investigators from the Insurance Fraud Bureau of the Florida Department of Financial Services dubbed the case "The Tooth Fairy Robbery."
The company at the center of the accusations,AC Pediatrics Dentistry & Orthodontics, issued a statement to Local 10 News denying the allegations and blaming "disgruntled former employees."
"Unfortunately, the origin of this ugly debacle can be traced back to disgruntled former employees who were removed from their positions in 2022, and who are now obsessed with bringing down the company they worked for, without caring about the human cost," he said in a statement.
For the charges against them, the five people could spend up to 90 years in prison if they are found guilty.
Also in Florida, a man was sentenced to prison forbuy and sell more than 2.6 million of beneficiary identification numbers of the Medicare public health system.
Charles William McElwee, 36, was sentenced to 41 months in prison after pleading guilty to one count of conspiracy to violate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Other Medicare scams have emerged in recent months in Florida. A Miami chiropractor and doctor were found guilty of defrauding the public health systemfor more than 31 million dollars.
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