Dr. Miguel Rivera-Sanabria, Health Care Fraud, Puerto Rico 2018

Dr. Miguel Rivera-Sanabria, a doctor from Puerto Rico, has been arrested and charged with health care fraud, aggravated identity theft, and false statements. According to the indictment, from August 2013 to August 2017, Dr. Rivera-Sanabria submitted false and fraudulent claims to Medicare through claims submissions to Medicare Advantage plans for medical services that were never performed.

The defendant is accused of enriching himself by billing Medicare $252,055 for services that were never performed, and causing Medicare to pay $225,250 based on these false and fraudulent claims.

The indictment also alleges that Dr. Rivera-Sanabria billed for services to patients who were deceased. He is charged with aggravated identity theft and false statements for at least three instances where he used the names, date of birth, and social security number of deceased patients to bill for services.

The investigation was conducted by the Office of the Inspector General for the U.S. Department of Health and Human Services (HHS-OIG), the FBI, and the Drug Enforcement Administration (DEA). The case is being prosecuted by Assistant U.S. Attorney Edward Veronda of the Financial Fraud and Corruption Unit.

Dr. Rivera-Sanabria is facing potential penalties of up to ten years of imprisonment for the health care fraud charges, and a mandatory minimum term of two years of imprisonment for the aggravated identity theft charges.

The defendant is also facing a health care fraud forfeiture allegation of $225,250, which constitutes the amount of money Medicare paid the defendant, and a property located in Las Villas en Palmas II in the municipality of Humacao, PR.

The case is a reminder that billing federal health programs for medically unnecessary services is unacceptable and a waste of taxpayer funds. The U.S. Attorney’s Office is committed to protecting public funds and safeguarding the well-being of federal health care program beneficiaries.