An eight-member consortium that perpetrated an elaborate health care fraud scheme in Miami, and which resulted in fraudulent claims totaling over $80 million, finally saw its last member sentenced. Alberto Orian Gonzalez-Delgado was sentenced to 210 months on May 27, 2021 after pleading guilty to conspiracy to commit health care fraud and wire fraud.

According to court documents, the group directed nominee owners to purchase home health care agencies and open up shell accounts and sham corporations. The healthcare agencies had no medical staff, nor did they provide any services, but the owners ultimately recorded $80 million in fraudulent claims from 2016 to 2019 and collected $53 million in reimbursement. The Medicare reimbursements were then laundered through the vast network of accounts and sham corporations, before being liquidated as cash. Then in the ultimate escape move, the conspirators required the owners to move to Cuba, which has no extradition treaty with the United States, to avoid detection. The defendants even confiscated participants’ passports to prevent return travel back into the United States

The other defendants in this  healthcare fraud case, which is captioned  as United States v. Rubal, were sentenced as follows: Eduardo Rubal and Vicente Gonzalez Acosta who pleaded guilty to the same charges as Gonzalez-Delgado were sentenced to 210 months and  188 months, respectively; Alexander Fernandez, Yaxing Tapanes, and Jose Carlos Valladares Rivera,  who all pleaded guilty only to conspiracy to commit money laundering, were sentenced to 120 months, 97 months, and 97 months, respectively. Hector Suarez Gonzalez pleaded guilty to conspiracy to commit health care fraud and wire fraud and received 78 months. Antonio Jimenez, who was the most notable nominee owner in the scheme, owning ten shell companies in Florida alone, received 48 months.

The FBI and Department of Health and Human Services-Office of Inspector General was responsible for the investigation, and court documents indicate the aid of a confidential source in the investigation, which was also assisted by the Centers for Medicare and Medicaid Services’ Center for Program Integrity.

For more information, please see the DoJ press release.

This case was prosecuted criminally, however similar conduct can be prosecuted under civil health care fraud laws including the qui tam provisions of the False Claims Act, which allows private citizens with knowledge of fraud against the government to bring a case on behalf of the United States and share in any recovery.  For more information on reporting health care fraud under the qui tam provisions of the False Claims Act, please contact Frohsin Barger & Walthall.