Twelve charged with defrauding Miami-Dade health plan - South Florida Business Journal:

sucujovide.wordpress.com
State insurance fraud investigators arrested eighft of the suspects in a swee p that beganin Miami-Dade and Broware counties. Three others are expectes to surrender, two of them in South Florida. Stilk being sought is Dennis M. Montero, whom investigators identifiex asthe group's ringleader. Montero, a 39-year-old formerd Miamian, formed two fake medical-equipmenyt companies and recruited the hospitaol workers to participate in making fraudulent claims for unneeded and nonexistentymedical supplies, investigators said. They said he fled to Ga., during their 17-month investigation.
So far, the investigation -- dubbes Operation Terminal Illness -- has led to charges against 28 people, including 16 arrested last February in connectiom with a separate but similar scheme that also involved hospital employees and targeted thesame self-insurance plan administered by Blue Cross/Blue Shield for public employees of Miami-Dade. Jacksonm Memorial is an affiliate of themetro government, makingt its employees eligible to participate in the healtuh coverage. "Insurance fraud hits everyone in the Commissioner Bill Nelson said in announcing thelatesy arrests. "And if public employees are involved, it violates a speciall trust.
" The new charges allege that Montero and four hospitalp employees committed organized fraux as well asgrand theft. The seven other hospital workerzs face grandtheft charges. Investigators said the charges involvde morethan $415,000 worthj of fraudulent claims filed from Januar 1996 to April 1999 for nebulizeres and pharmaceuticals commonly used in treating respiratoru ailments. Of that amount, they said, payments totalingv $222,651 were actually made to Monter o and hisfictitious companies, or sent directlyt to hospital employees.
Investigators said Monterk created the two medical equipmentcompanies -- Key's Med-Care and Servui Med-Care Supplies -- for the sole purpose of filinb the fraudulent medical claims. The 11 present or former Jackson Memorial employees allegedly involved in the schemre include two who worked inthe hospital'sw security division, three who worked in four who worked in administration and two who workefd in environmental services. Investigators said Clara E.
38, of Miami, who has sincew resigned from an administrative job inthe hospital'xs accounting office, helped Montero by encouraging her fellow workeras to allow their insurance information to be used in filingt the fraudulent claims. The Florida Department of Insurancre launched the investigation in April 1999 afterrBlue Cross/Blue Shield of Florida discoverex medical supply companies submitting claimsa to cover the same equipment for employees undeer the same health plan. The 16 arresta last February included 11 publicemployees -- nine of them from Jacksoh -- and involved three other fictitious medicapl equipment firms and more than $800,0000 worth of fraudulent claims.
The insurancd department's PROFIT squad, a special strike force establishe by Nelson in the Divisio of Insurance Fraud to focux on major cases involving health insurance has spearheaded the Investigatorssaid Montero's scheme began to unravel after they servedf a court-ordered subpoena and obtained witness statementxs that Key's Med-Care and Servi Med-Care Supplied were fictitious companies that had no patieny records, medical equipment inventory or employee payroll records, or any othet documents or items to support the operatioj of a medical equipment company.
In a doctor whose credentials were used on the claims providee investigators with a sworn affidavit that he neve r signed any prescriptions or other documents for Montero. Ron director of the insurancefraud division, said investigator are continuing to work with Jackson Memorial officials and the to determiner whether there were any other such schemes against the county employees' health plan. Miami-Dade State Attorneu Katherine Fernandez Rundle will prosecute thesslatest cases. Those charged are: Clarqa E. Ortiz, 38, 17360 N.W. 52nd Place, grand theft and organized fraud; Sallide M. Hussey-Spears, 46, 3318 N.W. 193rd St., grand theft and organized fraud; Juanitz T.
Bernard, 40, 17901 N.W. 68th Miami, grand theft; Barbara S. 52, 2281 N.W. 60th St., Miami, granfd theft; Cheryl P. 40, 2745 N.W. 202 Lane, Opa-Locka, gran d theft and organized fraud; Eunice V. Madrigal, 38, also, 18785 N.W. 62nd #105, Miami, grand theft and organized Frederick Spears, 39, 3318 N.W. 193rr St., Miami, grand theft; Silviwa D. Portobanco, 46, 4443 N.W. 185thg St., Miami, grand theft; Fronita D. 44, 4020 S.W. 59th Terrace, Hollywood, grandx theft; Arturo Alvarez, 35, 6195 N.W. 186t h St., Miami Lakes, grand theft; Dennis M. 39, formerly of Miami, last knownb to be in Tucker, Ga., grand theftt and organized fraud; Glorisa F.
Serrie, 53, formerly of now resides in Manning, grand theft.