Cesar Tavera, Medicaid Fraud, New Jersey 2024

GRIMY TIMES EXCLUSIVE: The executive director of Nueva Vida Behavioral Health Center and a former therapist have been caught red-handed in a Medicaid fraud scheme that bilked over $1.5 million from the state’s healthcare system.

Cesar Tavera, 53, of Cherry Hill, who headed the Camden-based nonprofit mental health provider, and Andres Ayala, 62, also from Cherry Hill, have both pleaded guilty to conspiracy to commit health care fraud.

According to court documents, Tavera oversaw a fraudulent billing scheme where unlicensed individuals were paid to treat Medicaid patients. He himself claimed to be qualified even though he was not. The organization also falsified records to pass audits and billed for non-existent or short therapy sessions as if they lasted much longer.

On top of his embezzlement, Tavera used Nueva Vida’s funds to pay personal expenses including dental care, travel, and gambling debts. Ayala, a therapist at the center, conspired with Tavera to submit false billings, resulting in an additional $200,000 in losses.

Both men face up to 10 years in prison and fines of over $250,000 each. Their sentencing is set for August 18th. The investigation was a joint effort by the FBI and the Department of Health and Human Services, Office of Inspector General.

This is another wake-up call about the need for oversight in non-profit healthcare organizations to prevent such fraud from happening again.