In a significant development, the final defendant involved in a large-scale health care fraud conspiracy has been sentenced to federal prison. Edgar Perez, a resident of Miramar, Florida, was sentenced to 12 months in prison, along with three years of supervised release. He was also ordered to pay restitution in the amount of $547,560. The conspiracy involved a total of 12 defendants who billed Blue Cross Blue Shield for over $53 million for medical services that were never provided. The defendants established multiple clinics in South Florida, using recruiters to obtain personal information of BCBS beneficiaries. Fraudulent bills were then submitted, and payments were transferred to personal accounts, laundered through various businesses and individuals. All defendants have pleaded guilty, with prison sentences ranging from 4 months to 52 months. The U.S. Attorney for the Southern District of Florida, Markenzy Lapointe, emphasized that such criminal behavior would not be tolerated, as it compromises the integrity of the healthcare system. The FBI, alongside the U.S. Attorney’s Office, played a crucial role in investigating and prosecuting the case, with a focus on seizing illegal income and assets as restitution.
Defendant Sentenced to Federal Prison
Final Defendant Sentenced to 12 Months in Federal Prison
Three Years of Supervised Release
Ordered to Pay $547,560.00 in Restitution
The final defendant in a 12-defendant health care fraud conspiracy has been sentenced to 12 months in federal prison. Edgar Perez, 51, of Miramar, Florida, was also ordered to serve three years of supervised release and pay $547,560.00 in restitution. This sentencing comes as a result of Perez’s participation in a health care fraud conspiracy that billed Blue Cross Blue Shield (BCBS) for over $53 million in fraudulent claims. These claims included services such as allergy tests and physical therapy that patients never received. This case highlights the commitment of law enforcement to bring those involved in health care fraud to justice and demonstrates the severe penalties that await those who engage in such illegal activities.
Background of the Health Care Fraud Conspiracy
Fraudulent Billing to Blue Cross Blue Shield
Services Never Received
The health care fraud conspiracy involved a total of 12 defendants, including Edgar Perez. These individuals conspired to defraud Blue Cross Blue Shield by submitting fraudulent billing claims. The claims were for services that patients never received, including allergy tests and physical therapy. By engaging in this deceitful scheme, the defendants sought to financially benefit through the manipulation of the health care system. Such fraudulent activities compromise the integrity of the system and undermine the trust of patients and providers alike.
Indictment and Charges
Indictment of 12 Defendants
Charges of Conspiracy and Health Care Fraud
The 12 defendants involved in the health care fraud conspiracy, including Edgar Perez, were indicted on July 28, 2022. They faced charges of conspiracy to commit health care fraud and wire fraud, as well as health care fraud. The indictment marked the beginning of a legal process aimed at holding these individuals accountable for their involvement in defrauding the health care system. These charges reflect the seriousness of the crimes committed and the impact they have on both patients and the integrity of the health care system as a whole.
Opening of Multiple Clinics
Defendants Opening Multiple Clinics in South Florida
Recruiters Providing Personal Information for BCBS Beneficiaries
As part of their fraudulent scheme, the defendants opened multiple clinics throughout South Florida. These clinics served as a front for their illegal activities and allowed them to submit fraudulent billing claims to Blue Cross Blue Shield. To further enable their deceit, the defendants utilized recruiters to provide personal information for BCBS beneficiaries. This information was then used to fabricate claims for services that were never provided. The defendants used these clinics and the stolen personal information to exploit the health care system for their financial gain.
Fraudulent Billing and Money Laundering
Submission of Fraudulent Bills to BCBS
Payments into Clinic Bank Accounts
Transfer to Personal Accounts and Cash Withdrawals
Money Laundering through Various Businesses and Individuals
Once the fraudulent claims were fabricated, the defendants submitted them to Blue Cross Blue Shield for payment. The payments were received into the bank accounts of the clinics operated by the defendants. From there, the defendants transferred the funds to their personal accounts and made cash withdrawals. To further obscure the illegal origins of the funds, the defendants engaged in money laundering through various businesses and individuals. This money laundering process allowed them to hide the proceeds of their fraudulent activities and make it increasingly difficult for law enforcement to trace the money trail.
Guilty Pleas and Sentences
Guilty Pleas of All Defendants
Sentences for Each Defendant
Restitution Agreement of Over $9 million
All 12 defendants involved in the health care fraud conspiracy, including Edgar Perez, have entered guilty pleas. Their guilty pleas reflect their acknowledgment of their involvement in defrauding the health care system and their acceptance of responsibility for their actions. Each defendant has received a sentence commensurate with their level of involvement in the conspiracy. Edgar Perez was sentenced to 12 months in federal prison, along with three years of supervised release, and ordered to pay restitution in the amount of $547,560.00. The combined restitution agreement for all defendants involved in the conspiracy exceeds $9 million. These sentences and restitution orders serve as a deterrent to others who may consider engaging in similar fraudulent acts.
Impact on the Healthcare System
Compromising the Integrity of the Healthcare System
Stealing from Patients with True Medical Needs
The health care fraud conspiracy perpetrated by the defendants had far-reaching consequences for the integrity of the health care system. By submitting fraudulent claims and billing Blue Cross Blue Shield for services patients never received, the defendants compromised the trust that is crucial to the functioning of the system. In addition to compromising the integrity of the system, the defendants also stole from patients with true medical needs. The funds siphoned off through their fraudulent activities could have been used to provide quality care to those in need. Instead, they were stolen for personal gain, further exacerbating the financial burden on those who rely on medical services.
Law Enforcement Efforts
FBI Investigation of the Case
Efforts to Bring Defendants to Justice
Seizure of Illegal Income and Assets for Restitution
The investigation into the health care fraud conspiracy was conducted by the FBI, emphasizing the commitment of law enforcement to combatting such illicit activities. The FBI’s efforts were aimed at bringing all 12 defendants to justice and recovering the proceeds of their illegal activities. Through their diligent work, law enforcement was able to identify and apprehend the defendants, ensuring that they faced the consequences of their actions. In addition to the criminal sentences imposed on the defendants, law enforcement also seized illegal income and assets as part of the restitution process. These efforts highlight the dedication of law enforcement to protect the integrity of the health care system and hold accountable those who seek to defraud it.
Announcement by U.S. Attorney and FBI
Announcement by U.S. Attorney Markenzy Lapointe
Announcement by Special Agent in Charge Jeffrey B. Veltri of FBI Miami
U.S. Attorney Markenzy Lapointe and Special Agent in Charge Jeffrey B. Veltri of the FBI Miami Field Office announced the sentencing of the final defendant in the health care fraud conspiracy. In their announcement, they emphasized the seriousness of the crimes committed by the defendants and the impact they had on the health care system. U.S. Attorney Lapointe reiterated the commitment of the Southern District of Florida to prosecuting individuals who compromise the integrity of the health care system. Special Agent in Charge Veltri highlighted the detrimental effects of health care fraud, particularly on vulnerable populations. The joint announcement by these officials underscores the collaborative effort between law enforcement agencies to address health care fraud and protect those who rely on the system for their medical needs.
Related Press Releases on Health Care Fraud Cases
For more information on health care fraud cases, including updates on related press releases, please visit the official website of the United States District Court for the Southern District of Florida at www.flsd.uscourts.gov or the PACER website at http://pacer.flsd.uscourts.gov under case number 22-cr-20341. These resources provide valuable insights into the ongoing efforts to combat health care fraud and hold offenders accountable for their actions.