Two Florida men were sentenced for their roles in a multi-state scheme to defraud insurance companies by using rural hospitals to bill for urine drug testing that was not reimbursable and not medically necessary. Jorge Perez, 63, of Miami, was sentenced to eight years and four months in prison. Ricardo Perez, 60, also of Miami, was sentenced to six years and three months in prison. According to court documents and evidence presented at trial, Jorge Perez, an owner and manager of hospitals and the owner of a billing company, and Ricardo Perez, the manager of a billing company, conspired with each other and other individuals to unlawfully bill for laboratory testing services, primarily urine drug tests, that were medically unnecessary and that were fraudulently billed through rural hospitals in Florida and Missouri rather than the independent laboratories where much of the testing took place.
Jorge Perez and Ricardo Perez targeted and obtained control over financially distressed rural hospitals, and then used them for billing in order to take advantage of private insurance contracts that provided higher reimbursement rates for these hospitals than for out-of-network laboratories. The claims were submitted to falsely appear that the hospitals themselves did the laboratory testing when, in most cases, it was done by testing laboratories controlled by others, including a co-conspirator.
