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Description: Miami, Florida criminal defense lawyer represented defendant charged with health care fraud.

Carlos Rafael Saez Dorta, age 42, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
Veronica Ramos Hernandez, age 35, (clinic owner) was sentenced to 135 months in prison following a jury trial, three years’ supervised release, and ordered to pay $4,434,069 in restitution;
Michael Burrowes, age 43, (patient recruiter) was sentenced to 46 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $73,116.61 in restitution;
Dianelis Garcia Alvarez, age 41, (office manager) was sentenced to 35 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $357,256 in restitution; and
Deandre Mitchell Gabriel, age 33, (patient recruiter) was sentenced to 24 months in prison following a guilty plea, three years’ supervised release, and ordered to pay $30,810 in restitution;

The defendants recruited and paid off beneficiaries of Blue Cross Blue Shield (BCBS) health insurance plans, then billed BCBS for services the clinic either never provided or which were not medically necessary. The two clinic owners also used the business, Polyclinic Healthcare Corp., to fraudulently obtain COVID-19 relief funds.

According to evidence introduced in court, the billing fraud conspiracy resulted in more than $8 million in false claims being submitted to BCBS. Most of the claims were for unneeded or never-provided physical therapy treatments, such as electrical stimulation, ultrasound therapy, and therapeutic exercise, as well as for durable medical equipment.

Additionally, the evidence showed that in 2021 the clinic owners (Saez and Ramos) applied for a $607,585 Paycheck Protection Program (PPP) loan as well as a $500,000 Economic Injury Disaster Loan (EIDL) from the U.S. Small Business Administration (SBA). As a result, Saez and Ramos received over $1 million through these COVID-19 relief programs, stealing money that was meant for legitimate small businesses suffering from the devastating effects of the COVID-19 pandemic.

FBI Miami investigated the case. Assistant U.S. Attorneys Shannon Shaw and Stephanie Hauser for the Southern District of Florida prosecuted the case. Assistant U.S. Attorney Annika Miranda handled asset forfeiture.

CONSPIRACY TO COMMIT HEALTH CARE AND WIRE FRAUD/18:1349.F
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Outcome: See above.

Plaintiff's Experts:

Defendant's Experts:

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