MIAMI – The lead defendant in a 15-defendant $36 million health care fraud conspiracy was sentenced Oct. 26 to 104 months in prison.
Arisleidys Fernandez Delmas, 33, Miami, Florida, was sentenced to 104 months in federal prison followed by supervised release for his role in a health care fraud conspiracy against Blue Three years and ordered to pay $8,671,377 Cross Blue Shield (“BCBS”) was ordered to pay more than $36 million in restitution for physical therapy services that the patient never received. Fernandez Delmas and 11 other defendants have pleaded guilty in South Florida federal court to their participation in the scheme.
According to fact providers presented to the court, from August 2018 to February 2023, the scheme’s co-conspirators paid kickbacks to beneficiaries of BCBS-administered health insurance plans. The conspirators offered these kickbacks to employees of JetBlue Airways, AT&T Inc. and TJX Companies Inc. to induce the beneficiaries to serve as patients at 30 physical therapy clinics in South Florida. Co-conspirators who owned these clinics then submitted fraudulent health insurance claims to BCBS to obtain health care benefits that were not medically necessary or even provided.
According to court documents, the co-conspirators also paid kickbacks and bribes to their co-defendants in exchange for referring additional BCBS beneficiaries to physical therapy clinics so that more fraudulent health care claims could be submitted. The co-conspirators also paid licensed massage therapists, several of whom were among the convicted defendants, to act as “nominal owners” and operators of physical therapy clinics. This allowed the scheme’s leaders to circumvent various medical clinic licensing requirements and attempt to evade criminal prosecution.
The following defendants have pleaded guilty to participating in a fraudulent physical therapy billing scheme (please indicate if sentencing information is available):
- Pedro Hugo Prieto Garcia, of Miami, Florida, pleaded guilty on July 27 to conspiracy to commit health care fraud and health care fraud (Case No. 22-cr-20560-Williams ). Prieto Garcia was sentenced on Oct. 16 to 87 months in prison, followed by three years of supervised release, and ordered to forfeit $341,887.
- Leidys Delmas Garcia, of Miami, Florida, pleaded guilty on July 24 to conspiracy to commit health care fraud (Case No. 22-cr-20560-Williams). Delmas Garcia was sentenced on Oct. 16 to 68 months in prison, followed by three years of supervised release, and ordered to forfeit $1,599,933.33.
- Carlos Jose Martin Gomez of Miami, Florida, pleaded guilty on October 12 to conspiracy to commit health care fraud (Case No. 22-cr-20249-Altonaga). Martin Gomez’s sentencing hearing is scheduled for January 3, 2024.
- Julio Acosta Perez, of Homestead, Florida, pleaded guilty on June 14 to conspiracy to commit health care fraud (Case No. 22-cr-20561-Moreno). Acosta Perez was sentenced on September 6 to 37 months in prison, followed by three years of supervised release, and ordered to forfeit $822,524.21.
- Yohana Iriza, also known as Yohana Lozada, of Miami, Florida, pleaded guilty on April 4 to conspiracy to commit health care fraud (Case No. 22-cr-20562-Altman). Iriza was sentenced on August 4 to 33 months in prison, followed by three years of supervised release, and ordered to forfeit $367,207.64.
- Gabriel Lozada of Fort Myers, Florida, pleaded guilty on May 1 to conspiracy to commit health care fraud (Case No. 22-cr-20561-Altman). Lozada was sentenced on July 31 to 27 months in prison, followed by three years of supervised release, and ordered to forfeit $255,694.16.
- Emiliano Joaquin Garcia of Lakeland, Florida, pleaded guilty on April 18 to conspiracy to commit health care fraud (Case No. 22-cr-20560-Williams). Garcia was sentenced on Oct. 24 to 16 months in prison, followed by three years of supervised release.
- Anthony Lozada of Miami, Florida, pleaded guilty on April 4 to conspiracy to commit health care fraud (Case No. 22-cr-20562-Altman). Lozada was sentenced on Aug. 4 to 18 months in prison, followed by three years of supervised release, and ordered to forfeit $223,604.78.
- Daimara Borroto Garcia of Hollywood, Florida, pleaded guilty on May 4 to conspiracy to commit health care fraud (Case No. 22-cr-20560-Williams). Borroto Garcia was sentenced on September 18 to 14 months in prison, followed by three years of supervised release.
- Elias Caises Maurino of Miami, Florida, pleaded guilty on April 25 to conspiracy to commit health care fraud (Case No. 22-cr-20560-Williams). Molino was sentenced on Aug. 9 to six months in prison, followed by three years of supervised release.
- Linda Taylor, of Miami, Florida, pleaded guilty on August 28 to conspiracy to commit health care fraud (Case No. 23-cr-20248-Scola). Taylor’s sentencing hearing is scheduled for November 17.
Three other defendants have made initial appearances in federal court: Gabriel Jaime Mejia (22-cr-20560-Williams) of Miami, Florida; Yarlon Valdes Morejon (23-cr-20131-Scola) of Miami, Florida; and the State of Florida Ariel Gonzalez of Naples (23-cr-20248-Scola).
A complaint, information or indictment is merely an accusation, and all defendants are presumed innocent unless and until proven guilty in court.
The announcement was made by Markenzy Lapointe, U.S. Attorney for the Southern District of Florida, and Jeffrey B. Veltri, Special Agent in Charge of the FBI’s Miami Field Office.
The Miami FBI investigated the cases. Assistant U.S. Attorneys Will J. Rosenzweig and Michael B. Homer are prosecuting them. Assistant U.S. Attorney Annika Miranda is handling the asset forfeiture matter.
Relevant court documents and information can be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov, Case No. 22-cr-20560.
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