Lead defendant in a 15-defendant health care fraud conspiracy sentenced to federal prison

MIAMI – On Oct. 26, the lead defendant in a 15-defendant, $36 million health care fraud conspiracy scheme, was sentenced to 104 months in prison.

Arisleidys Fernandez Delmas, 33, of Miami, Florida, was sentenced to 104 months in federal prison, followed by three years of supervised release and ordered to pay restitution in the amount of $8,671,377, for her participation in a health care fraud conspiracy that billed Blue Cross Blue Shield (“BCBS”) for more than $36 million for physical therapy services that patients never received. Fernandez Delmas and 11 other defendants have pleaded guilty in federal court in South Florida for their participation in the scheme.

According to the factual proffers filed with the court, from August 2018 to February 2023, co-conspirators in the scheme paid kickbacks to beneficiaries of health insurance plans managed by BCBS. The co-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 South Florida physical therapy clinics. The co-conspirators who owned the clinics then submitted fraudulent health insurance claims to BCBS for health care benefits that were medically unnecessary and not even provided.

According to the court documents, these co-conspirators also paid kickbacks and bribes to their co-defendants in return for referring additional BCBS beneficiaries to the physical therapy clinics so more fraudulent health care claims could be submitted. These co-conspirators also paid licensed massage therapists—several of whom were among the defendants convicted—to act as “nominee owners” and operators of the physical therapy clinics. This allowed the leaders of the scheme to avoid various medical clinic licensing requirements and attempt to evade criminal prosecution.

The following defendants have pleaded guilty for their involvement in the fraudulent physical therapy billing scheme (sentencing information is noted where 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 Oct. 12, to conspiracy to commit health care fraud (Case No. 22-cr-20249-Altonaga). Martin Gomez’s sentencing hearing is scheduled on Jan. 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 Sep. 6, to 37 months in prison, followed by three years of supervised release and ordered to forfeit $822,524.21.

• Yohana Iriza (aka 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 Aug. 4, to 33 months in prison, followed by three years of supervised release and ordered to forfeit $367,207.64.

• Gabriel Lozada, of Fort Meyers, 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 Sep. 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). Maurino 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 Aug. 28, to conspiracy to commit health care fraud (Case No. 23-cr-20248-Scola). Taylor’s sentencing hearing is scheduled on Nov. 17.

The following three other defendants have made their initial appearances in federal court, Gabriel Jaime Mejia, of Miami, Florida (22-cr-20560-Williams); Yarlon Valdes Morejon, of Miami, Florida (23-cr-20131-Scola), and Ariel Gonzalez, of Naples, Florida (23-cr-20248-Scola).

A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent unless and until proven guilty in a court of law.

U.S. Attorney Markenzy Lapointe for the Southern District of Florida and Special Agent in Charge Jeffrey B. Veltri of FBI, Miami Field Office, made the announcement.

FBI Miami 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 asset forfeiture.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or at http://pacer.flsd.uscourts.gov, under case number 22-cr-20560.

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