North Carolina woman guilty of paying bribes, kickbacks and letting Miami clinics wrongly charge $34.6 million [The News & Observer (Raleigh)] – InsuranceNewsNet

A Chapel Hill a woman was found guilty on Thursday of paying bribes and kickbacks for nearly $35 million in physiotherapy services that have never been provided, the US Department of Justice reported.

Jaroslava Ruiz50 years old, was convicted by a federal jury in Miami, Floridaof conspiracy to commit health care fraud and wire fraud, and nine counts of health care fraud, department officials said in a news release.

She could serve up to 20 years in prison for conspiracy and up to 10 years in prison for each health care fraud, they said. She could be sentenced in federal district court on October 26.

Ruiz has been accused of working with others to defraud private health insurers of more than $34.6 million in “false and fraudulent claims for physiotherapy services”, justice department officials said in Monday’s statement.

According to a court filing, Ruiz’s co-defendant Jesus Porra managed and operated four Miami clinics involved in the program: Ramirez Rehab Center, Long Life Medical Services, A.A. Ortiz Medical Center and Perez Medical Center.

Ruiz, who lived in Miami Dade County at the time, was an office administrator for Porras, according to the court filing. Two other defendants Anisley Gomez Anuez and Lidia Rodriguez Oviedoalso worked as office administrators, he said.

Prosecutors accused Ruiz of paying bribes and bribes to patients and patient recruiters in exchange for authorizing the Miami physiotherapy clinics to bill for services that were never provided to patients. Clinics submitted more than $34.6 million in false and fraudulent claims and have been paid approximately $7.7 million from several private insurers, they said.

The fraudulent claims were filed between June 2016 and October 2020 with Blue Cross Blue Shield, Cigna and United Health Groupas well as private insurance plans offered by the employer for administrative services only, according to a court document.

The suspects “falsified medical records to create the impression that physiotherapy services were medically necessary, prescribed by a physician, and actually rendered,” the statement said. “In truth and in fact, none or virtually none of the alleged services had been provided.”

The fraudulently obtained products were used “for their personal use and benefit, the use and benefit of others, and to further the fraud,” according to a court document.

In March, a judge ordered Porras to be considered a fugitive from justice, according to court documents. His co-conspirators are due to be sentenced in September.

Rodriguez Oviedo pleaded guilty to two counts of healthcare fraud and conspiracy to commit healthcare fraud and wire fraud in June, and Gomez Anuez pleaded guilty to health care fraud and conspiracy to commit health care fraud and wire fraud in July.

The FBI continues to investigate the case, law enforcement officials said.

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