Cesar Tavera, Health Care Fraud, New Jersey 2017

Cesar Tavera, 53, the executive director of Nueva Vida Behavioral Health Center of New Jersey, a nonprofit provider of mental health services to Camden’s poorest residents, has pleaded guilty to defrauding New Jersey Medicaid.

Tavera admitted to conspiring to commit health care fraud and embezzling from a health care benefit program. He faces a maximum penalty of 10 years in prison and a fine of the greater of $250,000 or twice the gain or loss caused by the offense.

According to the court documents, most of Nueva Vida’s patients are on Medicaid, and Tavera controlled Nueva Vida’s billings to New Jersey Medicaid. He supervised the people at Nueva Vida who treated Medicaid patients. New Jersey Medicaid rules require that people giving mental health therapy to Medicaid recipients must either be licensed or have a master’s degree in mental health.

Tavera had several unlicensed, unqualified individuals treat Medicaid recipients and then billed Medicaid as if qualified therapists had treated the patients. Tavera himself treated Medicaid patients even though he was not qualified. He used several other fraudulent practices to obtain money from Medicaid, including billing for therapy that never happened and billing group therapy as if each participant received individual therapy.

Tavera embezzled money from the Nueva Vida bank account in addition to his salary and spent the money on himself and his family. He used the Nueva Vida bank account to pay for dental care, meals, travel in the United States and abroad, and the expenses of his daughter’s music career. Tavera paid no-show employees with cash and payroll checks from Nueva Vida’s bank account. He repeatedly withdrew cash at the Sugar House Casino in Philadelphia and used the money to gamble at the casino.

Ayala, a former therapist who worked at Nueva Vida Behavioral Health Center of New Jersey, also pleaded guilty to conspiring to commit health care fraud. According to the court documents, Ayala conspired with Tavera to submit false billings to New Jersey Medicaid. Ayala was responsible for $200,000 in losses to Medicaid.

Sentencing for both defendants is scheduled for August 18, 2017. Cesar Tavera embezzled more than $1.5 million from Nueva Vida, and the total loss to Medicaid is over $1.7 million.

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