Eighteen Miami-Dade County Residents Charged for their Alleged Participation in Private Insurance Health Care Fraud Scheme
Fourteen individuals were arrested today for their alleged participation in a scheme to defraud privately insured health care plans located in Miami-Dade County, including Cigna, Blue Cross Blue Shield (BCBS), United Health Care (UHC), Miami-Dade County Public Schools, City of Miami, Pepsi Co., BJ’s Wholesale Club, Inc., Lincoln Property Company, Macy’s Inc., Nextera Energy Inc., Radioshack Corporation, Sodexo, Inc., Southeast Frozen Foods Company LP, and other self-insured employers which offered Administrative Services Only (ASO) insurance plans to their employees.
ASO insurance plans reimbursed Cigna, BCBS, and UHS for the money paid out by the insurance companies for health benefits for their respective employees. Therefore, the employers acted in a self-insured role; making them financially responsible for any claim payments to their employees.
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, George L. Piro, Special Agent in Charge, FBI, Miami Field Office, Alysa D. Erichs, Special Agent in Charge, United States Immigration and Customs Enforcement, Homeland Security Investigations (ICE-HSI), J.D. Patterson, Director, Miami-Dade Police Department (MDPD), Ian A. Moffett, Chief, Miami-Dade Schools Police Department, Rodolfo Llanes, Chief, Miami Police Department (MPD), and Sergio Velazquez, Chief, Hialeah Police Department, made the announcement.
Reynaldo Castillo, 46, of Hialeah, Hendris Castillo Morales, 33, of Miami, Lisbet Castillo, 23, of Hialeah, Maite Garcia, 40, of Hialeah, Osvaldo Marin Medina, 48, of Hialeah, Alejandro Biart, 40, of Miami, Alejandro Jesus Cura, 47, of Miami, Dania Chavez, 43, of Miami, Ezequiel Severo Casas, 28, of Hialeah, Humberto Martinez Rodriguez, 43, of Hialeah, Jose Gerardo Gonzalez, 23, of Miami, Julio Suarez, 47, of Miami, Nelson Ramos, 56, of Miami, Reinaldo Cinta Gonzalez, 46, of Miami, Rudy N. Dominguez, 25, of Hialeah, and Diulys Martinez, 39, of Miami, were charged with Conspiracy to commit Health Care Fraud and Health Care Fraud in United States v. Reynaldo Castillo, et al., Case No. 15-20144-Cr-Scola. In addition, Maite Garcia was charged with Conspiracy to Pay Health Care Kickbacks and Payment of Kickbacks in Connection with a Federal Health Care Program.
As alleged in the indictment, Reynaldo Castillo, Hendris Castillo Morales, Lisbet Castillo Batista, and Maite Garcia owned and controlled 30 companies based in Miami, Hialeah, Hialeah Lakes, and Doral, Florida. These individuals utilized medical director staffing companies to obtain and misappropriate the names and licensing information for numerous physicians. This information was then used to submit false and fraudulent claims to the private insurance plans.
The indictment further alleges that Alejandro Biart accepted kickbacks from co-conspirators in return for referring Cigna, BCBS, and UHC beneficiaries to the medical clinics controlled by Reynaldo Castillo, Hendris Castillo Morales, Lisbet Castillo Batista, and Maite Garcia. These beneficiaries signed documents falsely and fraudulently representing that they had received medical services when, in fact, they had not received medical services.
The indictment additionally charges Maite Garcia for her role in paying kickbacks and bribes to certain beneficiaries in order to reimburse the beneficiaries for their monthly premium payments to Cigna.
According to the indictment, Osvaldo Marin Medina, Humberto Martinez Rodriguez, Alejandro Jesus Cura, Dania Chavez, Ezequiel Severo Casas, Jose Gerardo Gonzalez, Julio Suarez, Nelson Ramos, Reinaldo Cinta Gonzalez, Rudy N. Dominguez and Duilys Martinez agreed, in exchange for a fee, to have companies be placed in their names, to open bank accounts and check cashing accounts in the names of the companies, and to cash and deposit checks received from Cigna, BCBS, and UHC.
The indictment alleges that as a result of this scheme, Reynaldo Castillo together with his co-conspirators, submitted and caused to be the submitted false and fraudulent claims to private insurance plans, including Cigna, BCBS, UHC, and ASO insurance plans managed by Cigna, BCBS, and UHC, on behalf of the medical clinics seeking approximately $125,676,324.00, as reimbursement for injection treatments, physical therapy treatments, and other medical items and services which were neither ordered by a physician nor provided to a beneficiary as claimed. Based on these false and fraudulent claims, Cigna, BCBS, and UHC, as well as, ASO insurance plans managed by Cigna, BCBS, and UHC, paid the medical clinics approximately $13,853,392.00.
The indictment further alleges that Reynaldo Castillo, Lisbet Castillo Batista, and Hendris Castillo incorporated Investors Group of Florida Corp. to receive proceeds from the medical clinics and utilized those proceeds to purchase real estate properties. Investors Group of Florida Corp. was listed as owner of the purchased real estate properties and acted as the leasing agent. Reynaldo Castillo was the president and registered agent of Investors Group of Florida Corp. The real properties are subject to criminal forfeiture as specified in the indictment.
Osvaldo Marin Medina and Alejandro Biart were also charged in United States v. Ernesto Castillo, et al., Case No. 15-20017-Cr-Ungaro, together with Ernesto Castillo, 43, of Hialeah, and Danny Jacomino Bordon, 50, of Miami, for Conspiracy to Commit Health Care Fraud and Health Care Fraud.
The indictment alleges that Ernesto Castillo, Osvaldo Marin Medina, Alejandro Biart, Danny Jacomino Bordon, and their co-conspirators submitted and caused Amazing Medical Services Inc. (Amazing) to submit claims to Cigna seeking reimbursement in the amount of approximately $1,111,183.00, which claims falsely and fraudulently represented that medical services were prescribed by a doctor and provided to Cigna beneficiaries by Amazing. As a result of such false and fraudulent claims, Cigna made payments to Amazing in the approximate amount of $86,035.00.
The indictment further alleges that Ernesto Castillo, Osvaldo Marin Medina, Alejandro Biart caused Serenity Rehabilitation Center, Inc. (Serenity) to submit fraudulent claims to Cigna seeking reimbursement in approximately $1,806,800.00, which resulted in reimbursement payments to Serenity in the approximate amount of $252,259.00. The defendants also caused World of Rehabilitation Therapy, Inc. (World Rehab) to submit fraudulent claims to Cigna seeking reimbursement in the amount of approximately $2,245,300.00, which resulted in payments to World of Rehab from Cigna in the approximate amount of $889,151.00.
The indictment alleges that defendant Alejandro Biart accepted kickbacks from co-conspirators in return for referring Cigna beneficiaries to Amazing, Serenity, and World of Rehab.
Jose Gerardo Gonzalez, Reynaldo Castillo, Ezequiel Severo Casas, and Danny Jacomino Bordon remain at large.
Mr. Ferrer thanked the FBI, ICE-HIS, MDPD, Miami-Dade Schools Police Department, MPD, and the Hialeah Police Department for their investigative efforts. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
An indictment is only an accusation and the defendants are presumed innocent until proven guilty.