Maryland Man Sentenced to 46 Months in Prison for Stealing Over $1 Million in Scheme Involving False Health Insurance Claims
Phony Claims Submitted to Wife’s Insurance Carrier
|U.S. Attorney’s Office September 25, 2012|
WASHINGTON—Luis Rodriguez, 47, of Bethesda, Maryland, a contractor with the Federal Aviation Administration, was sentenced today to 46 months in prison on a charge stemming from the submission of false health care claims, announced U.S. Attorney Ronald C. Machen, Jr. and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office.
Rodriguez pled guilty in June 2012 in the U.S. District Court for the District of Columbia to one count of health care fraud. He was sentenced by the Honorable Richard W. Roberts. Upon completion of his prison term, Rodriguez will be placed on three years of supervised release. He also was ordered to pay $1,014,475 in restitution and to forfeit money and assets totaling $1,014,475. The court also entered a stipulated order of removal, meaning Rodriguez is expected to be deported from the United States upon completion of his 46-month sentence.
According to a statement of offense signed by the defendant as well as the government, Rodriguez is a Spanish national who is in the United States on a G-4 work visa, due to his wife’s employment with the Inter-American Development Bank (IDB). The IDB is an international financial institution established in 1959 by the Organization of American States that maintains its principal offices in Washington, D.C. The IDB is the largest source of development financing for Latin America and the Caribbean and is funded by its 48 member countries, including the United States, which holds 30.01 percent of the IDB’s shares and is the largest shareholder. The United States Secretary of the Treasury serves on the bank’s Board of Governors.
The IDB offers health insurance to all of its staff members and their eligible dependents. IDB’s health insurance plan is administered by CIGNA. Persons covered under the plan may pay their doctor or medical provider out-of-pocket and then submit claims for reimbursement to the IDB, through CIGNA.
From March 2006 through April 2010, Rodriguez submitted approximately 880 reimbursement claim forms to CIGNA, identifying over 25,000 individual services such as physical therapy that Rodriguez claimed had been provided to him or his two minor children. The bills submitted by Rodriguez totaled more than $1.3 million.
In fact, all of those claims were false: none of the claimed services had ever been provided. Based on the submission of false claims, CIGNA sent checks to Rodriguez for more than $1.25 million. Because the fraud was discovered in time to stop payment on some of the checks, the IDB’s actual loss was just over $1,014,475.
When Rodriguez realized federal authorities were investigating his fraud scheme, he devised a plan to obstruct the federal investigation. Rodriguez attempted to impersonate a senior IDB official and ordered CIGNA to tell the FBI to close the investigation without further action.
The restitution in this case is to be paid to the IDB.
In announcing the sentence, U.S. Attorney Machen and Assistant Director in Charge McJunkin praised the special agents who investigated the case from the FBI’s Washington Field Office. They also expressed appreciation for the assistance provided by the IDB and CIGNA. They also acknowledged the efforts of those who worked on the case from the U.S. Attorney’s Office, including Legal Assistant Nicole Wattelet and Assistant U.S. Attorney Anthony Saler, who assisted with the forfeiture aspects of the case. Finally, they commended the work of Assistant U.S. Attorney Ted L. Radway, who prosecuted the matter.