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Fraud & Identity Theft

Ringleader of Complex Medicare Fraud Ring Faces Prison Sentence

Fraudster used Genuine Medicare Beneficiary Information Illegally Obtained, Setup Clinics that Never Physically Existed

Fraudster used Genuine Medicare Beneficiary Information Illegally Obtained, Setup Clinics that Never Physically Existed

Alberto Noriega, of Miami, has been sentenced to federal prison for leading a Medicare fraud ring that submitted more than $9 million in false and fraudulent Medicare claims for alleged infusion therapy services at false clinics in Texas and the Southeast.

Over time, Noriega and his co-conspirators submitted approximately $9,129,420 in false and fraudulent infusion therapy claims to seven insurance companies. To submit the claims, Noriega used genuine Medicare beneficiary information including names, social security numbers and dates of birth—that he illegally obtained from a number of sources.

According to information presented in court, for at least the last two years, Noriega’s scheme targeted the Medicare Advantage Plan (MAP). MAP is a health care benefit program that allows Medicare beneficiaries to obtain their benefits through private insurance companies rather than through the traditional Medicare program. From Florida, Noriega dispatched his co-conspirators, including Cuban nationals, to various cities in Texas and across the southeastern United States, to serve as “nominee” or “straw” owners for infusion therapy clinics that would allegedly operate in several cities. Their involvement was limited to signing paperwork to set up the clinics, while Noriega controlled them. Noriega’s infusion therapy clinics would purportedly offer infusion therapy, injection therapy and other expensive medical treatment designed to treat patients suffering from cancer, HIV and AIDS.

To set up the clinics, Noriega directed the nominee owners to incorporate the clinics in the states in which they purportedly operated. However, none of the clinics had actual business locations or any personnel; the clinics existed only on paper. The primary locations of the clinics were rented UPS store mailboxes. Using the address of the rented mailbox and the identity of the nominee owner among other information, Noriega obtained a National Provider Identifier (NPI) for each clinic. The NPI was used by Medicare to submit the claims.

The claims were falsified to include diagnoses that the Medicare beneficiaries did not have and listed expensive infusion therapy services that were never performed. The insurance companies would issue reimbursement checks to the clinics, and the nominee owners would deposit them into their account before they funneled them back to Noriega.

As part of their agreement with Noriega, the nominee owners were paid large sums of cash and were required to leave the United States after their work was done. Many fled to Cuba to avoid extradition to the United States, as there is no extradition treaty between the two countries. However, Noriega’s primary co-conspirator, Miguel Miranda, of Miami, was caught, and pleaded guilty to conspiracy to commit health care fraud.

Noriega faces 63 months in federal prison without parole, followed by a three-year-term of supervised release. He is also ordered to pay $1,440,367.00 in restitution to the victimized insurance companies.

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