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February 27, 2015

Two Miami Residents Sentenced to 72 Months in Prison for Their Roles in $63 Million Medicare Fraud Scheme

WASHINGTON—Two Miami residents were sentenced to serve 72 months in prison for their roles in a $62 million Medicare fraud scheme involving intensive mental health treatment programs.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement. U.S. District Judge Robert N. Scola Jr. of the Southern District of Florida imposed the sentence.

Blanca Ruiz, 61, and Alina Fonts, 49, both of Miami, were convicted of conspiracy to commit healthcare fraud following a trial in November 2014. Fonts was also convicted of two counts of health care fraud.

According to the evidence presented at trial, both Ruiz and Fonts were employed at Health Care Solutions Network Inc. (HCSN), a now-defunct partial hospitalization program (PHP) that purported to provide intensive treatment for severe mental illness. The evidence at trial demonstrated, however, that from 2004 through 2011, HCSN billed Medicare and Medicaid for treatment that was not medically necessary and often not provided at all. In Florida, HCSN operated community mental health centers at two locations.

Evidence at trial showed that Ruiz and Fonts oversaw the alteration, fabrication and forgery of thousands of documents, including patient medical records, to support the fraudulent claims HCSN submitted to Medicare and Medicaid. Many of these medical records were created weeks or months after the patients were admitted to HCSN facilities for purported treatment. The evidence at trial demonstrated that the “therapy” at HCSN oftentimes consisted of nothing more than Disney movies and bingo games, and Ruiz and Fonts removed any references to these recreational activities in the medical records. Fonts also fabricated medical records for North Carolina-based patients whom she never met.

According to the evidence presented at trial, Ruiz and Fonts were also aware that HCSN paid illegal kickbacks to owners and operators of Miami-Dade County assisted living facilities in exchange for patient referrals to be used to submit false and fraudulent claims to Medicare and Medicaid. Ruiz and Fonts knew that many of the referred patients were ineligible for PHP services because they suffered from mental retardation, dementia and Alzheimer’s disease.

From 2004 through 2011, HCSN billed Medicare and the Medicaid program approximately $63 million for purported mental health services.

This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorneys Allan J. Medina, Brendan A. Stewart and Justin Goodyear of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.

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