Florida Men Sentenced for Insurance Fraud Scheme Involving Rural Hospitals

Two Florida men were sentenced today for their roles in a multi-state scheme to defraud insurance companies by using rural hospitals to bill for urine drug testing that was not reimbursable and not medically necessary.

Jorge Perez, 63, of Miami, was sentenced to eight years and four months in prison. Ricardo Perez, 60, also of Miami, was sentenced to six years and three months in prison.

According to court documents and evidence presented at trial, Jorge Perez, an owner and manager of hospitals and the owner of a billing company, and Ricardo Perez, the manager of a billing company, conspired with each other and other individuals to unlawfully bill for laboratory testing services, primarily urine drug tests, that were medically unnecessary and that were fraudulently billed through rural hospitals in Florida and Missouri rather than the independent laboratories where much of the testing took place.

Jorge Perez and Ricardo Perez targeted and obtained control over financially distressed rural hospitals, then used them for billing to take advantage of private insurance contracts that provided higher reimbursement rates for these hospitals than for out-of-network laboratories. The claims were submitted to falsely appear that the hospitals themselves did the laboratory testing when, in most cases, it was done by testing laboratories controlled by others, including a co-conspirator.

Much of the testing was for vulnerable addiction treatment patients and patients of pain clinics, with samples often obtained through kickbacks paid to recruiters and substance abuse treatment facilities. The tests billed by Jorge Perez and Ricardo Perez were often not medically necessary — testing was performed at a frequency that far exceeded what would be needed for patient care, including performing repeated screening and definitive testing before results from prior tests could have been reviewed or used by the ordering providers.

The rural hospitals involved in this case were Campbellton-Graceville Hospital (CGH), a 25-bed rural hospital located in Graceville, Florida, that declared bankruptcy in 2017; Regional General Hospital Williston (RGH), a 40-bed facility located in Williston, Florida, that has closed; and Putnam County Memorial Hospital (Putnam), a 15-bed rural hospital located in Unionville, Missouri, that has struggled since Jorge Perez and Ricardo Perez’s misuse of it as a vehicle for laboratory billing.

On June 27, 2022, a federal jury in the Middle District of Florida convicted Jorge Perez and Ricardo Perez of conspiracy to commit health care fraud and wire fraud, five counts of health care fraud, and conspiracy to commit money laundering.

The investigation was led by the FBI Jacksonville Field Office, OPM-OIG, DOL-OIG, and Amtrak OIG. Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division, U.S. Attorney Roger B. Handberg for the Middle District of Florida, Assistant Director Michael Nordwall of the FBI’s Criminal Investigative Division, Deputy Assistant Inspector General for Investigations Conrad J. Quarles of the Office of Personnel Management Office of the Inspector General (OPM-OIG), Special Agent in Charge Mathew Broadhurst of the Department of Labor Office of Inspector General (DOL-OIG) Southeast Region, and Special Agent in Charge Basil Demczak of Amtrak Office of Inspector General’s (Amtrak OIG) Central Field Office made the announcement.

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