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Puerto Rican doctor arrested for health care fraud

By on July 24, 2018

SAN JUAN  –  On July 19, a federal grand jury in the District of Puerto Rico returned an indictment charging Dr. Miguel Rivera-Sanabria, who was arrested Tuesday, with 18 counts of health care fraud, three counts of aggravated identity theft, three counts of false statement and eight counts for attempted distribution of controlled substances, the Justice Department announced.

According to a release, from about August 2013 to August 2017, Rivera-Sanabria “enriched himself by submitting false and fraudulent claims to Medicare through claims submissions to Medicare Advantage plans for medical services that were never performed,” billing Medicare $252,055 and receiving “$225,250 based on these false and fraudulent claims.”

The identity theft and false statements charges were “for at least three instances where he billed for services to patients who were deceased.” The indictment alleges the defendant “knowingly transferred, possessed, and used the names, date of birth, and social security number, attached to the supplier’s unique Medicare identification number of three patients who in fact were deceased” at the time of the alleged psychiatric evaluation claims.

“Billing federal health programs for medically unnecessary services is unacceptable and a waste of taxpayer funds,” Rosa Rodríguez Vélez, U.S. attorney for the District of Puerto Rico, is quoted as saying in the release.

Rivera Sanabria is facing a “health care fraud forfeiture allegation of $225,250, which constitutes the amount of money Medicare paid the defendant, and a property located in Las Villas en Palmas II in the municipality of Humacao.”

He faces potential penalties of up to 10 years of imprisonment for the fraud charges, and a mandatory minimum term of two years of imprisonment for the identity theft charges.

The Office of the Inspector General for the U.S. Department of Health and Human Services is in charge of the investigation with the collaboration of the FBI and the Drug Enforcement Administration, and the case is being prosecuted by Assistant U.S. Attorney Edward Veronda of the Financial Fraud and Corruption Unit.

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