Tampa, Florida - Jose Pascual (36, Naples) pleaded guilty today to conspiracy to commit health care fraud. Pascual faces a maximum penalty of 10 years in federal prison.
According to the plea agreement, beginning in or around January 2007, up through March 31, 2008, Jose Pascual formed a criminal partnership with various co-conspirators to fraudulently bill the Medicare Program (“Medicare”), specifically Medicare Part B, for physical and occupational therapy services that were not rendered to any Medicare beneficiaries. In furtherance of this conspiracy, he purchased an existing Outpatient Physical Therapy provider (“OPT”) called R&R Outpatient, LLC (“R&R Outpatient”), which was located in the Middle District of Florida.
Pascual staffed R&R Outpatient to give the false appearance that it was a legitimate OPT, when, in fact, it was not. Essentially, R&R Outpatient was an empty shell that served the sole purpose of defrauding Medicare. To maximize the number of Medicare beneficiaries that could be fraudulently billed under R&R Outpatient’s provider number, Pascual and his co-conspirators paid kickbacks and bribes to Medicare beneficiaries who were primarily residing in the Miami-Dade County area, to serve as phony patients of R&R Outpatient. Pascual and his co-conspirators paid these Miami-area beneficiaries with kickbacks and bribes so that R&R Outpatient could use the beneficiaries’ health insurance claim numbers (“HICNs”) to bill Medicare for physical therapy services that were not provided. Pascual and his co-conspirators fabricated medical records to support R&R Outpatient’s fraudulent claims for reimbursement under Medicare.
On or about July 23, 2007, the Centers for Medicare and Medicaid Services informed R&R Outpatient that its Medicare provider agreement had been terminated. In hopes of trying to confuse Medicare and forestall the imminent shutdown of R&R Outpatient, Pascual transferred ownership of R&R Outpatient, at least on paper, to another co-conspirator, or nominee owner. In truth, however, he still maintained substantial control of R&R Outpatient.
Between February and September 2007, R&R Outpatient, as directed by Pascual and his co-conspirators, billed Medicare for physical and occupational therapy services that were not rendered, resulting in over $1,000,000.00 of Medicare funds being paid out for these fraudulent claims. Around September 2007, Pascual and his co-conspirators took the Medicare beneficiary information paid for with kickbacks and bribes and submitted additional fraudulent claims to Medicare by using other bogus physical therapy clinics located in the Middle District of Florida (the “co-conspirator clinics”). These additional, fraudulent claims resulted in Medicare payments being made to the co-conspirator clinics. The co-conspirator clinics then shared in these fraud proceeds by wiring over $160,000.00 to R&R Outpatient’s bank account.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and the Defense Criminal Investigative Service. It is being prosecuted by Assistant United States Attorney Simon Gaugush.