10 Indicted In Billing Fraud Involving Putnam County Memorial Hospital

Ten individuals, including hospital managers, laboratory owners, billers and recruiters, have been charged tor their participation in an elaborate pass-through billing scheme using rural hospitals in several states as billing shells to submit fraudulent claims for laboratory testing.
The indictment alleges that from approximately November 2015 through February 2018, the conspirators billed private insurance companies approximately $1.4 billion for laboratory testing claims as part of this fraudulent scheme and were paid approximately $400 million. Among the facilities involved was Putnam County Memorial Hospital at Unionville.
Jorge Perez, 60, of Miami-Dade County, FL; Seth Guterman, 54 of Chicago, IL; Ricardo Perez, 57 of Miami-Dade County, FL; Aaron Durall, 48 and Neisha Zaffuto, 44, both of Broward County, FL; Christian Fletcher, 34 of Atlanta, GA; James Porter Jr., 49 of Marion County, FL; Sean Porter, 52 of Citrus County, FL; and Aaron Alonzo, 44 and Nestor Rojas, 45, both of Miami-Dade County, FL were charged in an indictment filed in the Middle District of Florida.
All defendants, except for Sean Porter, were charged with one count of conspiracy to commit health care fraud and wire fraud. In addition, Jorge Perez, Guterman, Ricardo Perez and Durall were each charged with five counts of substantive health care fraud. Durall and Zaffuto were charged with two counts of conspiracy to commit money laundering and Jorge Perez, Guterman, Ricardo Perez, Fletcher, James Porter and Sean Porter were charged with one count of conspiracy to commit money laundering. Charged with substantive money laundering were Durall (three counts), Zaffuto (one count), Jorge Perez (seven counts), Guterman (one count), Ricardo Perez (five counts), Fletcher (two counts), James Porter (12 counts) and Sean Porter (two counts).
The indictment alleges that the conspirators would take over small, rural hospitals, often in financial trouble, using management companies they owned and operated. The conspirators would then bill private insurance companies through those rural hospitals for millions of dollars of expensive urinalysis drug tests and blood tests, conducted mostly at outside laboratories they often controlled or were affiliated with, using billing companies that they also controlled. While outside laboratories did most of these laboratory tests, the conspirators allegedly billed private insurance companies as if these laboratory tests were done at the rural hospitals.
According to the indictment, the hospitals had negotiated contractual rates with private insurers that provided for higher reimbursement than if the tests were billed through an outside laboratory, using the hospitals as a shell to fraudulently bill for such tests. The indictment alleges that the lab tests were often not even medically necessary. The conspirators allegedly would obtain urine specimens and other samples for testing through kickbacks paid to recruiters and health care providers, often sober homes and substance abuse treatment centers. The indictment also alleges that the conspirators engaged in sophisticated money laundering to promote the scheme and to distribute the fraudulent proceeds.
In addition to Putnam County Memorial, hospitals in Graceville, FL, Willison, FL and Dahlonega, GA were also involved.
Jorge Perez, Ricardo Perez, and Durall appeared on Monday before U.S. Magistrate Judge Joel B. Toomey of the Middle District of Florida. Initial appearances for Zaffuto, Fletcher, James Porter Jr., Sean Porter, Aaron Alonzo, and Nestor Rojas are scheduled before Magistrate Judge Toomey today and Wednesday.