Readers of the Allegiant Experts Blog are well aware that health care fraud is an epidemic that is impacting every single state in our great nation. The issue, in fact, is so grave that it even impacts U.S. territories. That’s right. You don’t even have to be an official state in order for America’s great health insurance plans to be illegally taken advantage of.

Earlier this month, the United States Department of Justice confirmed that with a report from their District of Puerto Rico branch. According to the report, Dr. Juan José Tull-Abreu was sentenced to a 63-month prison sentence for defrauding Medicare. In addition, he will serve 24 months for aggravated identity theft, for a total term of 87 months imprisonment. That’s a little over seven years if you’re trying to work out the math.

You may also be trying to work out how a Puerto Rican doctor was able to defraud Medicare – a United States health insurance program. Puerto Rico, while not a state, is considered an “unincorporated territory” of the United States. Puerto Ricans are considered natural-born citizens of the United States and the American dollar is the currency used on their island. For all intents and purposes, the people of Puerto Rico are entitled to the health insurance benefits offered by the programs available in the continental United States.

Unfortunately, that means that Medicare and other health insurance programs are just as susceptible to fraud at the hands of the island’s doctors as they are doctors from the mainland. Dr. Tull-Abreu is proof of that. He is guilty of submitting claims to Medicare Advantage health insurance plans for medical services that he never rendered. During his trial, evidence showed that he submitted thousands of false and fraudulent claims for services that he claimed to have performed at his offices in Arecibo and Utuado.

According to testimony from Medicare and other insurance carrier witnesses, Dr. Tull-Abreu submitted invoices for face-to-face office visits and face-to-face home visits on days when his office was actually closed to the public. He also submitted invoices for services rendered on days when he was out of the country.

In all, Dr. Tull-Abreu defrauded Medicare of $1,200,000.00. At his sentencing, he was ordered to pay $509,775.20 in restitution to the six Medicare Advantage insurance carriers that were affected by his fraudulent scheme.

Rosa Emilia Rodríguez-Vélez is the United States Attorney who tried the case against Dr. Tull-Abreu. “This prosecution and sentence should serve as clear message to those few dishonest members of the medical community in Puerto Rico of the stern consequences they will face for defrauding the Medicare program,” she is quoted as saying in the report, “We will not sit idly and allow doctors to illegally enrich themselves by engaging in fraudulent schemes that deplete the Medicare program of funds destined to assist and protect the elderly.”

The team of clinical experts, here at Allegiant Experts, also has no intention of sitting idly while doctors continue to engage in fraudulent activity that robs our health insurance programs of much-needed funding for legitimate health care. We remain dedicated to lending our experience and expertise to attorneys who are trying cases against perpetrators of health care fraud. If you’re an attorney who could use our assistance, please don’t hesitate to reach out to us.

Feel free to call us at 407-217-5831 or email us at info@allegiantexperts.com.