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  • Writer's pictureThe San Juan Daily Star

Justice Dept. files 61 charges of Medicaid fraud

By The Star Staff

Justice Secretary Domingo Emanuelli Hernández announced on Thursday that the Medicaid Fraud Control Unit (MFCU) has for the first time joined the National Health Care Fraud Enforcement Action initiative, a national effort to combat health care fraud.

“This coordinated action between the Puerto Rico Department of Justice and the United States Department of Justice to combat health care fraud nationwide seeks to generate significant attention to deter this type of crime,” Emanuelli Hernández said in a written statement.

During the period from June 10 to June 25, multiple states and territories of the United States, including Puerto Rico, filed indictments against individuals suspected of committing fraud in the Medicaid program. In Puerto Rico, the MFCU charged a doctor, a corporation and its administrator for illegal schemes through which they submitted false claims to the Medicaid program and health plans, managing to appropriate over $60,000 in public funds.

The first case was filed against the Laboratorio Clínico de San Juan corporation and its owner and administrator, Julio Martorell González. Prosecutor Brenda Rosado Aponte filed 17 charges against the defendant, which include illegal appropriation of public funds, illegal identity appropriation and fraud in the Medicaid program. The corporation faces 10 charges for violating articles 182 of the Penal Code and 3.07 of the Fraudulent Claims Act for Programs, Contracts and Services of the Government of Puerto Rico.

According to the investigation, between August 2018 and December 2022, the San Juan Clinical Laboratory submitted fraudulent claims to the Humana Health Plan, MCS Advantage, MMM, Plan de Salud Menonita and Triple S medical plans for $49,119.54. As part of the scheme, they appropriated the identities of Medicaid beneficiaries to bill and collect from the health plans.

The second case was filed against Dr. Luis Espinet García, who served as a dentist and provider for the Medicaid program. He is accused of making false and fraudulent claims for services he never provided, and deceptively charging patients excessive amounts of money for services included in the Medicaid program. The fraud amounts to $11,314.43 and involves 44 charges filed.

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