Miami Man Sentenced To More Than Three Years In Prison For Healthcare Fraud Scheme
Tampa, FL – U.S. District Judge Mary S. Scriven today sentenced Juan Gonzalez-Castro to 3 years and 1 month in federal prison for healthcare fraud. The court also ordered Gonzalez-Castro to forfeit $2,543,951.28, which are traceable to proceeds of the offense. Gonzalez-Castro pleaded guilty on August 7, 2013.
According to court documents, from at least in or around 2006, until at least in or around February 2010, Gonzalez-Castro knowingly and willfully conspired with others, including Dixan Barcelo-Castro, Jose Fresco, and Alfredo Barcelo-Rodriguez, to defraud Medicare Part C health plans. The co-conspirators, including Gonzalez-Castro, operated four clinics, all at the same location (2137 W. Martin Luther King Jr. Blvd., Tampa, Florida). Each clinic supposedly performed the same procedure (Endovenous Vein Ablation) on its patients. None of the conspirators are licensed medical professionals or has any experience operating a legitimate medical clinic.
The four clinics involved in the scheme were: (a) Palmetto General Health Care, Inc. (Palmetto); (b) United Healthcare Center, Inc. (United); (c) New Imaging Center, Inc. (New Imaging); and (d) Lord Physical Rehabilitation Center, Inc. (Lord Rehab). Gonzalez-Castro helped establish and operate the clinics and was listed as the President and Registered Agent of United and the Vice President and Secretary of New Imaging corporations.
All of the clinics operated at the same physical address, at the same time, and billed Medicare Part C HMOs for the same procedures on the same patients. They then billed Medicare Part C plans for those procedures. In reality, the procedure for which they billed, primarily Endovenous Vein Ablation, was never performed at these clinics. For example, various Part C plans would be billed for up to ten instances of Endovenous Vein Ablation in a single year for a single patient, when performing that number of procedures on a single person would be medically impossible. When interviewed, none of the "medical professionals" who worked at the clinics or any of their supposed beneficiaries provided or received medical treatment at the clinics or had any procedures that, when described, resembled vein ablation. The co-conspirators submitted or caused to be submitted multiple fraudulent claims for the same or similar patients using different entity names, simply by whiting out the letterhead and replacing it with another clinic's name.
The patient beneficiaries were complicit in the scheme and allowed themselves to be enrolled in several Medicare Part C plans to maximize the fraudulent billing. Once one plan was billed for a single patient to have this sham procedure, the beneficiary was re-enrolled in another Part C plan to repeat the fraudulent billing.
The co-conspirators used the four clinics to bill eight different Medicare Part C plans, which are healthcare benefit programs as defined in 18 U.S.C. 1347. The total intended loss identified to date is approximately $4,872,239, and the actual loss is approximately $2,543,951.28.
Dixan and Barcelo-Rodriguez remain fugitives. Fresco has pleaded guilty to his role in the scheme is scheduled for sentencing in December 2013.
This case was investigated by HHS-OIG. It is being prosecuted by Assistant United States Attorney Mandy Riedel.