Miami businessman sentenced to prison for Medicaid fraud with false Cuban owner who fled to the island.

José Dávila Núñez, a 51-year-old businessman residing in Miami, was sentenced on October 11 to 63 months in federal prison, followed by three years of supervised release, for his involvement in a Medicaid fraud scheme. In addition, Dávila was ordered to pay $3,869,703 in restitution.

Dávila had pleaded guilty on June 14 to conspiracy to commit fraud in the healthcare system. According to court documents and the agreed statement of facts, Dávila and his co-conspirators opened a mental health clinic called New Behavior Health Direction, Incorporated (New Behavior) in Hialeah Gardens, Florida, using a fake owner as a front. Between April 2019 and September 2020, they submitted false claims to Medicaid totaling $3,869,703, claiming to have provided psychosocial rehabilitation (PSR) services, a type of therapy aimed at helping individuals with disorders such as depression and anxiety. In September 2020, the fake owner withdrew the fraudulent earnings, gave part of the money to Dávila, and then fled to Cuba. Dávila's company, Max Medical Consulting Services, Incorporated, located in Miami, received approximately $500,000 of the fraudulent revenue generated by New Behavior.

During the sentencing hearing, Dávila was also held accountable for an additional fraud of $2,617,992. This amount was related to the bribes that he and his accomplices paid to patients between November 2018 and December 2022, in exchange for them receiving PSR services at three other clinics in Miami: Davila Medical Center, Incorporated, Advanced Community Wellness Center, and Larkin Behavior Health, Incorporated.

The U.S. government managed to confiscate approximately $1.7 million in cash related to New Behavior's bank accounts.

This case adds to the growing list of frauds in South Florida, many of which have involved Cuban citizens or people with ties to the island. The region has been the scene of numerous fraudulent schemes related to the healthcare system, particularly highlighting Medicaid and Medicare fraud, which has led authorities to intensify their efforts to combat these criminal activities in the area.

On April 1, 2024, the Cuban Ariel Núñez Finalet was sentenced to prison in Miami for defrauding Medicare of nearly 17 million dollars. Núñez was a fugitive for a decade, participating in a network that submitted fraudulent claims for unnecessary medications through pharmacies in Florida.

Subsequently, on April 3, 2024, a young woman from Hialeah, Lisandra Santana, was accused of staging an accident to collect insurance and therapy benefits, faking fake injuries to claim money. The police discovered that she herself had broken the airbag of the vehicle to make the fraud believable.

At the beginning of May, two Cuban women, María Campos and Isabela Méndez, were arrested for staging a fake car accident in Miami with the goal of filing fraudulent medical claims for over $35,000. One day later, on May 2, 2024, Krystal Arbona, another young Cuban woman, was accused of leading a $40,000 insurance fraud scheme following a car accident in Miami. Investigations revealed that the therapies claimed were never actually performed.

On July 2, 2024, authorities arrested Margelys Moreira Pino, a Cuban in Miami-Dade, for bribing patients to claim nonexistent medical services from Medicare. This scheme resulted in over $100,000 in fraudulent claims.

Finally, on July 23, 2024, another Cuban in Miami, Agustín García Marsán, was arrested for defrauding the elderly in a fraud scheme, using the "grandparents scam" to obtain thousands of dollars.