NC woman guilty of paying kickbacks, bribes, letting Miami clinics falsely bill $34.6M [The News & Observer (Raleigh)]

News & Observer (Raleigh, NC)

A Chapel Hill woman was found guilty Thursday of paying kickbacks and bribes for nearly $35 million in physical therapy services that were never provided, the U.S. Department of Justice reported.

Jaroslava Ruiz, 50, was convicted by a federal jury in Miami, Florida, of conspiracy to commit health care fraud and wire fraud, and nine counts of health care fraud, department officials said in a news release.

She could serve up to 20 years in prison on the conspiracy count, and up to 10 years in prison on each health care fraud count, they said. She could be sentenced in a federal district court on Oct. 26.

Ruiz was accused of working with others to defraud private health insurers of over $34.6 million in “false and fraudulent claims for physical therapy services,” Justice Department officials said in the release Monday.

According to a court filing, Ruiz’s co-defendant Jesus Porras managed and operated four Miami clinics involved in the scheme: Ramirez Rehab Center, Long Life Medical Services, AA Ortiz Medical Center and Perez Medical Center.

Ruiz, who lived in Miami-Dade County at the time, was an office administrator for Porras, the court filing said. Two more defendants, Anisley Gomez Anuez and Lidia Rodriguez Oviedo, also worked as office administrators, it said.

Prosecutors accused Ruiz of paying kickbacks and bribes to patients and patient recruiters in return for allowing the Miami physical therapy clinics to bill for services that were never provided to patients. The clinics submitted over $34.6 million in false and fraudulent claims and were paid roughly $7.7 million from several private insurers, they said.

The fraudulent claims were filed between June 2016 and October 2020 with Blue Cross Blue Shield, Cigna and United Health Group, as well as employer-offered, private Administrative Services Only insurance plans, according to a court document.

The suspects ”falsified medical records to give the impression that the physical therapy services were medically necessary, prescribed by a doctor, and actually rendered,” the release said. “In truth and fact, none or virtually none of the purported services had been provided.”

The fraudulently obtained proceeds were used “for their personal use and benefit, the use and benefit of others, and to further the fraud,” a court document said.

In March, a judge ordered that Porras be considered a fugitive from justice, court documents show. His co-conspirators are set for sentencing in September.

Rodriguez Oviedo pleaded guilty to two counts of health care fraud and conspiracy to commit health care fraud and wire fraud in June, and Gomez Anuez pleaded guilty to health care fraud and conspiracy to commit health care fraud and wire fraud in July.

The FBI is continuing to investigate the case, justice officials said.