Targeting the “Most Wanted Fugitives” in Healthcare Fraud

Topics: Financial Crime, Fraud, Government, Government Fraud, Government Regulation, Risk Management

We’ve all heard about the notorious criminals on the FBI’s “Ten Most Wanted Fugitives” list. It may bring images to mind of bank robbers with tommy guns or escaped convicts with leg iron shackles running from law enforcement à la O Brother, Where Art Thou? Whether alleged terrorists or murders, these individuals are suspected to be some of the worst offenders in the nation and the list serves to publicize their criminal activities in hopes of catching the crooks.

But as bank robbers with tommy guns are more of dime novel fiction than reality, law enforcement has turned some of their attention to stopping an even bigger drain on society: healthcare fraudsters. As healthcare costs soar and the opioid and emerging fentanyl epidemic continue to ravish the nation, the Office of Inspector General at the US Dept. of Health and Human Services (OIG HHS) decided to emulate the FBI’s model of publicizing the crooks in hopes as a way catch offenders engaging in health care fraud and abuse.

“With our Most Wanted Fugitives List, OIG is asking the public’s help in tracking down fugitives. The public has a stake in the fight against fraud, waste, and abuse,” said Inspector General Daniel R. Levinson back in 2011 when the list was first published.

Why Have a Most Wanted List?

Healthcare fraud costs the U.S. tens of billions of dollars every year. Federal enforcement efforts recover some of this money:

However, there are always individuals who escape law enforcement.

In 2011, the OIG initiated a Most Wanted Fugitives List to focus public attention on some of the worst healthcare fraud offenders. The list includes photos and profiles of each featured fugitive, as well as an online fugitive tip form and the OIG hotline number (1-888-476-4453.) Currently, the OIG is seeking more than 170 fugitives.

Current Top 10

The list currently features individuals who have defrauded government healthcare programs and often caused harm to their patients in the process, including:

  •        Angel Lagoa, who was indicted in January 2017 on charges of conspiracy to commit healthcare fraud and wire fraud. From 2010 to 2015, Lagoa and his co-conspirators allegedly submitted $30 million in false or fraudulent claims to Medicare from Trinity Senior Care, Inc. in Miami, Florida. Investigators believe Lagoa is currently living in Cuba.
  •        David Kim, who was indicted in October 2015 on charges of healthcare fraud, illegal remunerations and aggravated identity theft. Kim allegedly billed Medicare $15.2 million for fraudulent physical therapy services. Kim was a licensed chiropractor and owner of New Hope Clinic in Los Angeles, California. Kim allegedly recruited Medicare beneficiaries to his clinic, obtained their Medicare numbers and patient information and then shared that information with his co-conspirators. Investigators believe Kim may be in South Korea, China or Mexico.
  •        Maria Moreira and Miguel Hernandez, were indicted in November 2014 on charges of conspiracy and healthcare fraud for allegedly submitting $7 million in false claims to Medicare. They owned and operated two medical centers in Georgia, which purportedly offered therapy and pain management services. Instead, they allegedly provided medically unnecessary services or provided no services at all. Investigators believe Moreira and Hernandez may be living in Spain.

Captured OIG Fugitives

The OIG Most Wanted Fugitives List has had some successes. The list helped capture two former OIG fugitives this year alone:

  •        Etienne Allonce was taken into U.S. custody in September after he was expelled from Haiti. Allonce had been a fugitive for over a decade. Allonce and his wife, Helene Michel, were indicted in December 2007 on charges of healthcare fraud. They owned a New York-based durable medical equipment (DME) company and allegedly billed Medicare and Medicaid for wound care supplies that were never ordered or provided. Michel was convicted in 2013, sentenced to 12 years in prison and ordered to pay $4.4 million in restitution.
  •        Antonio Quevedo-Ledo was detained by U.S. Customs and Border Protection in March 2018 after arriving in Miami on a flight from Cuba. He had been indicted in 2010 on charges of healthcare fraud and forfeiture. In August, Quevedo-Ledo was sentenced to a year-and-a-half in prison and ordered to pay more than $440,000 in restitution.

Once captured, the OIG Most Wanted List fugitives are held accountable for their healthcare fraud:

  •        Maikel Chamizo Gomez was sentenced to 2 years and 5 months in prison in January 2017 and ordered to pay over $5 million in restitution.
  •        Joel Fuentes was sentenced to 2 years and 7 months in prison in March 2017 and ordered to pay over $2 million in restitution.
  •        Martinez Ruiz was sentenced to 3 years in prison in May 2017, ordered to pay $4.7 million in restitution and excluded from participating in any federal healthcare programs for 23 years.

Continuing to Expand the Tools to Fight Healthcare Fraud

The OIG Most Wanted List can help the government find and arrest those individuals who are costing the government and taxpayers the most. While law enforcement and regulators continue to combat this type of fraud from different angles, including larger, consolidated litigation actions to individual arrests against dentists and even addressing the bigger culprit, demand and the cycle of poverty, it will be useful to keep an on eye on these developments.

We will continue to monitor healthcare fraud, waste and abuse trends. Follow the Risk & Compliance page to stay up-to-date.

Gina Jurva, Manager, Attorney & Manager Risk & Compliance, contributed to this article.