On Oct. 26, the lead defendant in a 15-defendant, $36 million healthcare fraud conspiracy scheme, was sentenced to 104 months in prison. Arisleidys Fernandez Delmas, 33, of Miami, Florida, was sentenced to 104 months in federal prison, followed by three years of supervised release and ordered to pay restitution in the amount of $8,671,377, for her participation in a healthcare fraud conspiracy that billed Blue Cross Blue Shield (“BCBS”) for more than $36 million for physical therapy services that patients never received. Fernandez Delmas and 11 other defendants have pleaded guilty in federal court in South Florida for their participation in the scheme. According to the factual proffers filed with the court, from August 2018 to February 2023, co-conspirators in the scheme paid kickbacks to beneficiaries of health insurance plans managed by BCBS. The co-conspirators offered these kickbacks to employees of JetBlue Airways, AT&T Inc., and TJX Companies Inc. to induce the beneficiaries to serve as patients at 30 South Florida physical therapy clinics. The co-conspirators who owned the clinics then submitted fraudulent health insurance claims to BCBS for healthcare benefits that were medically unnecessary and not even provided.
According to the court documents, these co-conspirators also paid kickbacks and bribes to their co-defendants in return for referring additional BCBS beneficiaries to the physical therapy clinics so more fraudulent healthcare claims could be submitted. These co-conspirators also paid licensed massage therapists—several of whom were among the defendants convicted—to act as “nominee owners” and operators of the physical therapy clinics. This allowed the leaders of the scheme to avoid various medical clinic licensing requirements and attempt to evade criminal prosecution.
