A pair of Miami healthcare workers face six years in prison for their role in defrauding Medicare and Medicaid for $63 million through a scheme that involved thousands of fabricated claims for treatments that were never administered.
Blanca Ruiz and Alina Fonts used their positions at Health Care Solutions Network Inc., a now-defunct provider, to bill the government for treatments that were either unnecessary or were never provided, according to the Department of Justice.
Between 2004 and 2011, the pair forged documents that inflated the care of severely mentally ill patients in order to drain money from Medicare and Medicaid.
The actual treatments “oftentimes consisted of nothing more than Disney movies and bingo games,” the Justice Department said.
Ruiz and Fonts fabricated medical records for their patients weeks and even months after the fake treatments took place, removing all reference to the recreational activities before submitting claims to Medicare or Medicaid.
Health Care Solutions Network also paid kickbacks to the owners of local assisted-living homes so the owners would refer patients to the company for “treatment,” regardless of whether they were legally eligible to receive such care.
At least seven former employees of the Florida provider have been arrested for their involvement with the $63 million scheme.
