Rafael Arias, Medicare Fraud Scheme, FL 2023

Rafael Arias, 52, of Miami, is going away for 20 years — 240 months — behind bars for masterminding a $66 million Medicare fraud scheme that exploited vulnerable patients and looted taxpayer-funded health care dollars. The hard-charging home health agency owner was sentenced by U.S. District Judge Cecilia M. Altonaga, who ordered him to pay $66.4 million in restitution and forfeit all illicit proceeds tied to the scam.

Arias pleaded guilty on November 30, 2017, to one count of conspiracy to commit health care fraud and wire fraud. Between December 2007 and September 2015, he ran more than 20 home health care agencies across South Florida, often hiding behind nominee owners to shield his control. These shell operators falsely claimed ownership while Arias pulled the strings, funneling false claims to Medicare for services never rendered to patients who didn’t qualify.

The fraud machine ran on kickbacks. Arias and his co-conspirators paid illegal bribes to patient recruiters who delivered beneficiaries — often elderly or disabled — to his agencies. Those patients received no legitimate care, but their names generated hundreds of fraudulent billing submissions. To launder the cash, Arias handed out checks to associates to cash out, cycling millions through underground channels to enrich himself and fuel the scam.

He wasn’t alone. Aylen Gonzalez, 39, of Hialeah, a patient recruiter and clinic owner who co-owned two agencies, pleaded guilty in November 2017 and got 180 months. Ana Gabriela Mursuli Caballero, 51, of Miami — another recruiter and agency owner — copped to the same charge and was sentenced to 115 months. Rafael Cabrera, 51, also of Miami, admitted to money laundering and was hit with 71 months for hiding the fraud’s proceeds.

The takedown was led by the Medicare Fraud Strike Force, a joint task force under the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The FBI and HHS-OIG’s Miami Field Office spearheaded the investigation, tracking down paper trails, shell entities, and cash movements that exposed the full breadth of the conspiracy. Trial Attorneys Angela Adams and Jessica Collins prosecuted the case with relentless focus.

“Today’s sentencing sends a clear message to anyone who is considering defrauding the Medicare system: You will not only be caught, prosecuted, and sent to prison, but you will also have to pay back all of your ill-gotten gains,” said Acting Assistant Attorney General John P. Cronan. Special Agent in Charge Shimon R. Richmond of HHS-OIG added: “Arias assumed that in Medicare fraud lay a path to riches. Instead he discovered that we are working tirelessly with our law enforcement partners to protect patients and taxpayers while holding criminals accountable for their unlawful actions.”