Puerto Rico is a beautiful Caribbean island. However, it can be a bit tricky to define exactly what land the island represents. Puerto Rico is considered an unincorporated territory of the United States. It is neither a sovereign nation nor a U.S. state. Interesting, isn’t it? For many, it can be hard to tell which laws apply to the island which ones don’t. For example, although Puerto Ricans have been United States citizens since 1917, they do not have votes in the U.S. Congress.
On the other hand, there is a District of Puerto Rico branch of the United States Department of Justice. As a result, Puerto Ricans can be charged with such crimes as health care fraud under United States law. The DoJ confirmed that, last week, a Puerto Rican couple received such charges.
A husband and wife were indicted on health care fraud charges.
On September 24th, in San Juan, Robert Crespo Zamora and Carmen J. Pagán Domínguez were charged with health care fraud, aggravated identity theft, conspiracy to commit health care fraud, obstruction of a criminal investigation related to health care offenses and mail fraud conspiracy. The announcement was made by W. Stephen Muldrow, U.S. Attorney for the District of Puerto Rico.
According to the indictment, the married couple carried out their crimes approximately between November 2015 and May 2020. Zamora and Domínguez are accused of submitting over one thousand (1,002, to be exact) false and fraudulent claims for non-invasive cardiovascular studies to Medicare. The total amount of their bogus bills was $259,147.71. Of that amount, Cardiology Medical Group (CMG) and Cardiology Medical Services (CMS) received approximately $132,312.15.
The couple submitted numerous fraudulent claims to Medicare.
Domínguez is the owner and biller for CMG and CMS. Robert Crespo Zamora is a cardiovascular technician and owner and biller of Cardiovascular Prophylaxis & Evolution (CPE). Together, they submitted claims to Medicare for non-invasive cardiovascular studies that were allegedly performed by two cardiologists. Meanwhile, those services were not provided by any physicians.
In a second indictment, it is alleged that Zamora and Domínguez submitted at least 300 false and fraudulent non-invasive cardiovascular studies claims to Medicare. These submissions, totaling $439,890.00 took place from approximately January to May 2020. Of that amount, about $249,272.00 went to CPE.
The couple enriched themselves through their fraudulent activity.
Zamora caused the submission of claims for non-invasive cardiovascular testing, purportedly performed to Medicare beneficiaries. This was done although he and his wife knew that the testing services were not medically necessary. They were also aware that the test results were never interpreted by a cardiologist, licensed physician or any other qualified health care provider.
“The submission of false claims to federal health care benefit programs is unacceptable and a waste of taxpayer funds,” Muldrow is quoted as saying in the DoJ report, “Today’s arrests show the Department of Justice’s and its law enforcement partners’ firm commitment to protect public funds and to safeguard the well-being of Medicare and Medicaid beneficiaries.”
Are you an attorney who is currently trying a health care fraud case?
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