Nine Florida residents were arrested by the Federal Bureau of Investigation (FBI) after being charged by a federal grand jury in Miami with healthcare fraud and conspiracy to commit healthcare fraud. The fraud scheme allegedly involved tens of millions of dollars in fraudulent healthcare billing by 30 South Florida physical therapy clinics. According to allegations in three related indictments and statements by the government in federal court, the defendants—Arisleidys Fernandez Delmas, 32; her mother Leidys Delmas Garcia, 51; her husband Pedro Hugo Prieto Garcia, 32; Daimara Borroto Garcia, 32; Elias Caises Maurino, 52; Yohana Iriza (a/k/a Yohana Lozada), 51; her ex-husband Gabriel Lozada, 50; their son Anthony Lozada, 23; and Julio Acosta Perez, 40—conspired to submit approximately $37 million in fraudulent healthcare claims to Blue Cross Blue Shield.
From approximately 2018 to present, the defendants allegedly paid kickbacks to beneficiaries of health insurance plans managed by Blue Cross. They offered these kickbacks to employees of JetBlue Airways, AT&T Inc., and TJX Companies Inc. to induce the beneficiaries to serve as patients at various South Florida physical therapy clinics. The defendants who owned the clinics then submitted fraudulent health insurance claims to Blue Cross for healthcare benefits that were medically unnecessary and not even provided. These defendants also allegedly paid kickbacks and bribes to their co-defendants in return for referring additional Blue Cross beneficiaries to the physical therapy clinics so more fraudulent healthcare claims could be submitted. These defendants also allegedly paid licensed massage therapists—who also were arrested this morning—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.
