Justice Dept.: 3 indicted, arrested for healthcare fraud
SAN JUAN – On June 17, a federal grand jury in Puerto Rico returned a 43-count indictment charging Sophia Piñeiro-Ruscalleda, Dr. Alice Ruscalleda-Lebrón and Juan José Ruscalleda, former officials of New Health Med Group Inc. (NHMG), with health care fraud, aggravated identity theft, conspiracy to commit health care fraud and obstruction of a criminal investigation related to health care offenses.
They were arrested Wednesday, announced W. Stephen Muldrow, U.S. attorney for the District of Puerto Rico. The Office of Inspector General for the U.S. Department of Health and Human Services (HHS-OIG) was in charge of the investigation. The indictment was unsealed Wednesday upon the arrest of the defendants by HHS-OIG agents.
According to the indictment, in about “July 2015 through in or about March 2017, Sophia Piñeiro-Ruscalleda, Dr. Alice Ruscalleda-Lebrón and Juan José Ruscalleda enriched themselves by submitting or causing to be submitted false and fraudulent claims to the Medicare program,” the Justice Department said.
The claims were for services purportedly rendered by various providers on behalf of NHMG, when said providers did not render any such services and never worked for NHMG on the dates of service listed on the claims submitted.
“Defendants submitted and/or caused to be submitted to Medicare a total of 2,711 claims using various rendering providers’ identifiers totaling $194,960. The defendants are facing a health care fraud forfeiture allegation of $85,422, which constitutes the amount of money Medicare paid the defendants,” reads the department’s release.
“Defrauding the Medicare program by submitting false claims will not be tolerated and we will continue to work with our law enforcement partners to hold those responsible for their criminal actions,” Muldrow said. “Medical professionals who steal federal health care funds divert scarce resources that are needed to deliver essential services to beneficiaries. This case demonstrates our resolve in attacking fraud and restoring confidence in federal programs intended to benefit the citizens of Puerto Rico.”
If found guilty, the defendants face “maximum sentences of: (a) up to ten years in prison for charges relating to health care fraud and conspiracy to commit health care fraud; (b) up to five years’ imprisonment for the obstruction of a criminal investigation related to health care offenses; and (c) a mandatory two-year consecutive term in prison for aggravated identity theft,” Justice said.
The case was investigated by the HHS-OIG and was prosecuted by Assistant U.S. Attorney José Ruiz Santiago, Criminal Health Care Fraud Coordinator at the U.S. Attorney’s Office.