Florida Physical Therapy Clinic Owners, Employees Sentenced For Multiple Fraud Schemes: The U.S. Attorney’s Office Southern District of Florida announced that a federal district judge in Miami sentenced the last of five defendants for his role in a health care fraud scheme operated out of a physical therapy clinic in Doral, Florida. According to court records, the defendants recruited and paid off beneficiaries of Blue Cross Blue Shield (BCBS) health insurance plans, then billed BCBS for services the clinic either never provided or which were not medically necessary. The two clinic owners also used the business, Polyclinic Healthcare Corp., to fraudulently obtain COVID-19 relief funds.

According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS.  Most of the claims were for unneeded or never-provided physical therapy treatments, such as electrical stimulation, ultrasound therapy, and therapeutic exercise, as well as for durable medical equipment.

Additionally, the evidence showed that in 2021 the clinic owners applied for a $607,585 Paycheck Protection Program (PPP) loan as well as a $500,000 Economic Injury Disaster Loan (EIDL) from the U.S. Small Business Administration (SBA).  As a result, they received over $1 million through these COVID-19 relief programs, stealing money that was meant for legitimate small businesses suffering from the devastating effects of the COVID-19 pandemic.

The five defendants were sentenced as follows:

  • Carlos Rafael Saez Dorta, age 42, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
  • Veronica Ramos Hernandez, age 35, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
  • Michael Burrowes, age 43, (patient recruiter) was sentenced to 46 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $73,116.61 in restitution;
  • Dianelis Garcia Alvarez, age 41, (office manager) was sentenced to 35 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $357,256 in restitution; and
  • Deandre Mitchell Gabriel, age 33, (patient recruiter) was sentenced to 24 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $30,810 in restitution.

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If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, other federal agencies/programs, or private health insurance companies and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.

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