Home Health Fraud Prompts $40 Million Payback, 15-Year Sentence

Three Miami residents have been sentenced and ordered to comply with a $40 million payback for participating in what’s considered the largest Medicare fraud scheme prosecuted in Southern Florida in 2015.

Jorge Lorenzo, 36, was sentenced to more than 15 years in prison Friday after pleading guilty to conspiracy to commit health care and wire fraud, according to the U.S. Attorney’s Office of the Southern District of Florida. Yahima Pardo, 33, and Roberto De Jesus Alonso, 48, both must serve more than three years in prison for conspiracy to commit health care and wire fraud and conspiracy to commit money laundering, respectively. The three men must also pay $40.3 million in restitution to the Medicare program.

Lorenzo, Pardo and De Jesus Alonso participated in the health care fraud, money laundering and kickback schemes over the course of four years, resulting in more than $40 million in losses to the Medicare program, according to court records. Over the course of those four years, Lorenzo owned and/or led eight home health agencies around Miami-Dade County that collectively received those fraudulent claim payments.

To carry out the scheme, Lorenzo had fake owners at his home health agencies, and they were tasked with authorizing millions of dollars in Medicare claim payments through corporate checks made out to fictitious companies staffed by other participants, court records show. These participants then laundered the fraudulently obtained money to Lorenzo. The Medicare payments were made for claims that weren’t medically necessary, never rendered and in some cases were linked to prescriptions Lorenzo counterfeited.

In total, Lorenzo’s eight home health agencies were operational for an average of only eight months before Lorenzo ordered them to close down when a Medicare fraud investigation became apparent.

Additionally, Lorenzo directed other participants in the scheme to incorporate more than 15 shell companies, which were employed to disguise the flow of more than $25 million bilked from Medicare for Lorenzo’s personal benefit. He used the money to buy real estate, luxury vehicles, artwork and jewelry, according to court records.

Meanwhile, De Jesus Alonso incorporated at least two of the fictitious companies to launder payments, which were intended to benefit elderly, blind and disabled patients.

Another man, Sonmy Rodrigues, 45, also of Miami, was sentenced earlier last week to nearly two years in prison for his role in the scheme. In a separate case, 30 Miami-area health care facilities, including home health agencies, were implicated in a historically large $1 billion fraud bust.

Written by Kourtney Liepelt