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Medicare and Medicaid Scam Unfolds in Florida and Beyond
Eight residents of Miami-Dade County and three residents of Nicaragua have been charged with their alleged participation in a $25.2 million Medicare, Medicaid, and wire fraud scheme.
According to a federal indictment, the defendants allegedly recruited individuals who resided in Nicaragua and the Dominican Republic to enroll in Medicare Advantage plans and Florida Medicaid by falsely representing that they resided in Florida.
The indictment alleges that the defendants caused the Center for Medicare and Medicaid services to make monthly capitation payments to Medicare Advantage plans and the Florida Medicaid program to pay Medicare premiums and deductibles for many beneficiaries who did not reside in Florida.
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Pam Bondi, Florida Attorney General, Derrick L. Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Wendy A. Bashnan, Special Agent in Charge, U.S. Department of State, Diplomatic Security Service (DSS), made the announcement.
The defendants, who include Pedro Hernandez, Freddy Zeron, Erendira V. Delgado, Edgardo Rodriguez, Rodney Montoya, Santiago Bernabe Montoya, Jose Eloy Sanchez, Abram J. Rodriguez, Mirna L Blanco, Deborah Smith, and Augustin Abaga, are charged with conspiracy to commit health care fraud and wire fraud, substantive counts of health care fraud, conspiracy to defraud the United States and make false statements related to health care matters, and substantive counts of making false statements related to health care matters.
The indictment alleges that the defendants used non-residential addresses, the addresses belonging to friends and relatives of these foreign residents, and addresses associated with the defendants to falsely represent the foreign residents’ residency in Florida.
Eight individuals have been arrested, while Freddy Zeron, Edgardo Rodriguez, and Jose Eloy Sanchez remain at large. In addition to the indictment, the government is pursuing a parallel civil action to freeze the assets of various defendants for approximately $10 million in fraudulent proceeds.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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