Doctor Brothers Jose And Carlos Lopez Diaz Sentenced For Health Care Fraud

SAN JUAN, P.R. – Yesterday and today, doctor brothers José and Carlos López-Díaz were sentenced to 121 months and 36 months and one day of imprisonment respectively, and three years of supervised release for their participation in a conspiracy to commit health care fraud, announced United States Attorney for the District of Puerto Rico, Rosa Emilia Rodríguez-Vélez. U.S. District Court Judge Francisco A. Besosa imposed the sentences and ordered José López-Díaz to be committed immediately to the Metropolitan Detention Center while Carlos López-Díaz was allowed to voluntary surrender upon designation by the Bureau of Prisons.

Doctor José López-Díaz and his brother Doctor Carlos López-Díaz were arrested on September 1, 2011, after a Federal grand jury returned 20-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $727,729.16. The investigation was lead by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS). They were found guilty by a jury of their peers on June 13, 2012.

According to the indictment, José Lopez-Díaz a general practitioner licensed to practice medicine in Puerto Rico, was billing for Medicare services not rendered.  The services billed and not rendered included: billing Medicare for 10,231 claims for medical treatment allegedly provided to Medicare patients at Guaynabo Medical Mall’s Emergency Room, even though he had never worked at such institution and never saw the patients; billing of Medicare code 53085, known as “Drainage Perineal Urinary Extravasation”, a procedure which was allegedly performed by José López-Díaz on female patients, when this procedure can only be performed on male patients.  José Lopez-Díaz never provided medical treatment to the Medicare beneficiaries whose identities he used in order to bill Medicare.

Over the period of time referred to in the Indictment, José Lopez-Díaz fraudulently billed Medicare for $3,591,298.90 and received the amount of $727,729.16 in Medicare reimbursements. He was also ordered to pay the amount of $1,028,691.55 in restitution and a Special Monetary Assessment of $3,400.

Doctor Carlos López-Díaz is a licensed dentist in Puerto Rico and the brother of José Lopez-Díaz.  Over the course of the health care fraud scheme, Carlos López-Díaz conspired with his brother to defraud Medicare and provided him with names and Medicare beneficiary numbers of patients treated by Carlos López-Díaz at his dental clinic in order for his brother to bill Medicare for services not rendered to those patients.

“We are pleased with the sentences of these two defendants,” said United States Attorney, Rosa Emilia Rodríguez-Vélez.  “These demonstrate that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population in order to enrich themselves. “May these sentences serve as an example for the medical community in Puerto Rico of what could be the consequences they can face if they defraud the Medicare program.”

“We are proud to be a part of the federal team that brought these defendants to justice for defrauding the Medicare program and exploiting the elderly,” said Thomas O’Donnell, Special Agent in Charge of the Office of Inspector General’s New York Regional Office which also covers Puerto Rico. “Arresting owners and providers, freezing their assets and prosecuting them to the fullest extent possible, are some of the tools that the federal government has available, and will be utilized to remove these individuals from participating in the Medicare program.”

HHS-OIG, USSS and the FBI, the investigative agencies received substantial collaboration from the Special Investigative & Compliance Units from Medical Card System Inc., Triple-S Salud, Medicare y Mucho Màs and Preferred Medicare Choice.

The case was prosecuted by Assistant U.S. Attorney Ernesto López-Soltero and Special Assistant U.S. Attorney Wallace A. Bustelo.