Five employees of a dental management company have been accused of defrauding insurance for over a million dollars through dental clinics in Hialeah and Little Havana.
M. L, 53 years old; C. O., 47; L. R., 22; L. R., 34; and R. V., 33, were arrested this Tuesday on charges including filing false insurance claims, organized fraud, and criminal use of personal information, according to arrest reports accessed by Local 10 News.
The five -four of them of Cuban origin- are alleged to have participated in an insurance fraud scheme worth 1.3 million dollars at two dental clinics in South Florida.
The suspects allegedly used the identification of dentists who no longer worked at their clinics to bill the insurance and added unnecessary procedures to collect extra fees.
According to the police report, in 2020, a couple sold their dental clinic shares, with practices located in Hialeah and in the Little Havana neighborhood of Miami, to a management company composed of the five individuals involved.
Subsequently, the company terminated the couple and allegedly implemented operations that violated Florida's regulations regarding dental clinics owned by non-dentists.
Authorities stated that the company continued to bill insurance companies for procedures using the identities of dentists who no longer worked there.
The suspects also requested six associated dentists to "accept a new billing process" in which procedures performed by dental assistants "would be signed off by existing accredited doctors even though they did not administer or oversee the treatments."
However, the dentists disagreed with this process because they would not be supervising it, would not be compensated, and did not want their licenses used without their direct oversight, the police report stated.
Authorities also revealed that Leonel Ravelo instructed the manager of the Little Havana office to use something called a "behavior management code" with all children under the age of six "without the knowledge and consent of the doctors, in order to boost productivity and meet financial goals for a monetary bonus."
The six dentists uncovered this scheme to commit fraud by including claims for services not rendered and stopped the billing, the report adds, and conducted an audit of all claims related to "behavior management code."
His audit revealed 50 fraudulent claims, four of which had already been submitted, amounting to a total of $1,800 in fraud.
"The material evidence, the sworn testimonies of the witnesses, and the financial records will demonstrate that Olson, Vázquez, and Ravelo knew about and conspired to correct and cover up this fraud after the dentists confronted them," the note stated.
The total amount of the fraud reached 1,350,246 dollars, according to the authorities.
The investigators from the Insurance Fraud Office of the Florida Department of Financial Services named the case "The Theft of the Tooth Fairy."
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 dates back to disgruntled former employees who were dismissed from their positions in 2022, and who are now obsessed with bringing down the company they worked for, regardless of the human cost," it stated in a statement.
For the charges they face, the five individuals could face up to 90 years in prison if found guilty.
Also in Florida, a man was sentenced to prison for buying and selling over 2.6 million identification numbers of beneficiaries from the public health system Medicare.
Charles William McElwee, 36 years old, was sentenced to 41 months in prison after pleading guilty to a charge of conspiracy to violate the 2015 Medicare Access and CHIP Reauthorization Act (MACRA).
Other Medicare scams have come to light in recent months in Florida. A chiropractor and a doctor from Miami were found guilty of defrauding the public health system of more than 31 million dollars.
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