10 Charged In $1.4B Health Insurance Scam In Florida

Jun. 30--In one of Florida's biggest healthcare schemes, 10 business people from Miami and elsewhere have been charged with submitting $1.4 billion in bogus bills for urinalysis and blood tests through rural hospitals, federal prosecutors said Monday.

An indictment charges the defendants with bilking Florida Blue and other private insurance companies, which paid out $400 million for tests that were actually done by private labs instead of the rural hospitals. In doing so, the defendants were able to boost their reimbursements because the rural hospitals qualified for higher insurance payments between 2015 and 2018, according to the U.S. Attorney's Office in Jacksonville.

"This was allegedly a massive, multi-state scheme to use small, rural hospitals as a hub for millions of dollars in fraudulent billings of private insurers," said Assistant Attorney General Brian A. Benczkowski of the Justice Department's Criminal Division.

Among those charged with conspiring to commit healthcare fraud: Jorge Perez, 60, Ricardo Perez, 57, Aaron Alonzo, 44, Nestor Rojas, 45, and Neisha Zaffuto, 49, all of Miami-Dade County, along with Aaron Durall, 48, of Broward County.

Also charged in the indictment: Seth Guterman, 54, of Chicago; Christian Fletcher, 34, of Atlanta; James Porter Jr., 49, of Marion County, Florida; and Sean Porter, 52, of Citrus County, Florida.

The indictment alleges that some of the defendants, including Jorge Perez, took over several financially troubled rural hospitals and billed private insurers such as Florida Blue for expensive urinalysis and blood tests that were mostly conducted at outside laboratories.

In a news release, prosecutors said "these rural hospitals had negotiated contractual rates with private insurers that provided for higher reimbursement than if the tests were billed through an outside laboratory. Accordingly, the scheme used the hospitals as a shell to fraudulently bill for such tests."

The indictment further alleges that the tests were often not even medically necessary. Perez and others who controlled the rural hospitals and test labs are accused of paying kickbacks to patients with drug addictions staying at so-called sober homes as well as to healthcare providers.

The rural hospitals involved in the alleged scheme are: Cambellton-Graceville Hospital in Graceville, Florida; Regional General Hospital in Williston, Florida; Chestatee Regional Hospital in Dahlonega, Georgia; and Putnam County Memorial Hospital in Unionville, Missouri.

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