Doctor Indicted And Arrested For Health Care Fraud

SAN JUAN, P.R. -  On July 19, 2018, a Federal Grand Jury in the District of Puerto Rico returned an indictment charging Dr. Miguel Rivera-Sanabria with 18 counts of health care fraud, three counts of aggravated identity theft, three counts of false statement relating to health care matters, and eight counts for attempted distribution of controlled substances. The defendant was arrested today, announced Rosa Emilia Rodríguez Vélez, United States Attorney for the District of Puerto Rico. The Office of the Inspector General for the U.S. Department of Health and Human Services (“HHS-OIG”) is in charge of the investigation with the collaboration of the FBI and the Drug Enforcement Administration (DEA).

According to the indictment, from on or about August 2013, and continuing through on or about August 2017, Dr. Miguel Rivera-Sanabria enriched himself by submitting false and fraudulent claims to Medicare through claims submissions to Medicare Advantage plans for medical services that were never performed. Rivera-Sanabria fraudulently billed Medicare $252,055, and he caused Medicare to pay $225,250 based on these false and fraudulent claims.

The defendant is also charged with Aggravated Identity Theft and False Statements for at least three instances where he billed for services to patients who were deceased. The indictment alleges that the defendant knowingly transferred, possessed, and used the names, date of birth, and social security number, attached to the supplier’s unique Medicare identification number of three patients who in fact were deceased at the time of the alleged psychiatric evaluation claims.

“Billing federal health programs for medically unnecessary services is unacceptable and a waste of taxpayer funds,” said U.S. Attorney Rosa E. Rodriguez-Velez. “Today’s arrest shows the Department of Justice’s firm commitment to protect public funds and to safeguard the well-being of federal health care program beneficiaries.”

Rivera-Sanabria is facing a health care fraud forfeiture allegation of $225,250, which constitutes the amount of money Medicare paid the defendant, and a property located in Las Villas en Palmas II in the municipality of Humacao, PR.

Pursuant to the charges, the defendant faces potential penalties of up to ten years of imprisonment for the health care fraud charges, and a mandatory minimum term of two years of imprisonment for the aggravated identity theft charges. This case was investigated by HHS-OIG, FBI, and DEA, and is being prosecuted by Assistant U.S. Attorney Edward Veronda of the Financial Fraud and Corruption Unit.

Indictments contain only charges and are not evidence of guilt. Defendants are presumed to be innocent unless and until proven guilty.

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