Husband And Wife Indicted And Arrested For Health Care Fraud | USAO-PR

SAN JUAN, Puerto Rico – On September 24, 2020, a Federal Grand Jury in the District of Puerto Rico returned two separate indictments charging Robert Crespo Zamora and Carmen J. Pagán Domínguez with health care fraud, aggravated identity theft, conspiracy to commit health care fraud, obstruction of a criminal investigation related to health care offenses, and mail fraud conspiracy, announced W. Stephen Muldrow, U.S. Attorney for the District of Puerto Rico.  The Office of Inspector General for the United States Department of Health and Human Services (HHS-OIG) led the investigation with the collaboration of the United States Postal Inspection Service (USPIS). The indictments were unsealed today upon the arrest of the two defendants by federal law enforcement officers from the HHS-OIG and USPIS.

A first indictment alleges that, from in or about November 2015, through in or about May 2020, defendants Carmen J. Pagán Domínguez and Robert Crespo Zamora, enriched themselves by causing the submission of at least one thousand two (1,002) false and fraudulent claims for non-invasive cardiovascular studies to Medicare, in the amount of $259,147.71. Cardiology Medical Group (CMG) and Cardiology Medical Services (CMS) received approximately $132,312.15 for the fraudulently submitted claims.  During the scheme, Carmen J. Pagán Domínguez, the owner and biller for CMG and CMS, and Robert Crespo Zamora, a cardiovascular technician, caused the submission of claims to Medicare for non-invasive cardiovascular studies allegedly performed by two cardiologists, even though those services were not provided by said physicians.   

According to a second indictment, from in or about January 2020, through in or about May 2020, defendants Robert Crespo Zamora and Carmen J. Pagán Domínguez enriched themselves by causing the submission of at least three hundred (300) false and fraudulent non-invasive cardiovascular studies claims to Medicare in the amount of $439,890.00. Cardiovascular Prophylaxis & Evolution (CPE) received approximately $249,272.00 for the fraudulently submitted claims.  During the scheme, Robert Crespo Zamora, the owner and cardiovascular technician for CPE, and Carmen J. Pagán Domínguez, biller for CPE, caused the submission of claims for non-invasive cardiovascular testing, purportedly performed to Medicare beneficiaries, although defendants knew said testing services were not medically necessary, and the test results were never interpreted by a cardiologist, licensed physician, or any other qualified health care provider.

“The submission of false claims to federal health care benefit programs is unacceptable and a waste of taxpayer funds,” said U.S. Attorney W. Stephen Muldrow. “Today’s arrests show the Department of Justice’s and its law enforcement partners’ firm commitment to protect public funds and to safeguard the well-being of Medicare and Medicaid beneficiaries.”

“Health care professionals must be held to a high standard of ethical behavior,” said Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region (“HHS-OIG”).  “Along with our law enforcement partners, HHS-OIG will continue to ensure that those individuals and entities that bill federal health care programs do so in an honest manner.”

“United States Postal Inspectors will continue to aggressively investigate criminals who use the USPS and its products for illegal gain.  We are committed to working with our law enforcement partners to investigate and bring to justice those who commit these types of offenses, and especially the impact that these financial crimes have on individuals, businesses, and government agencies alike,” said James V. Buthorn Inspector in Charge, USPIS Newark Division, San Juan Field Office.

If found guilty, the defendants face maximum sentences of: (a) up to ten years in prison for charges relating to health care fraud, conspiracy to commit health care fraud, and mail fraud conspiracy; (b) up to five years imprisonment for the obstruction of a criminal investigation related to health care offenses; and (c) a mandatory two-year consecutive term in prison for aggravated identity theft.

The case was investigated by the HHS-OIG and USPIS, and will be prosecuted by Assistant U.S. Attorney José Ruiz Santiago, Criminal Health Care Fraud Coordinator at the United States Attorney’s Office.

Indictments contain only charges and are not evidence of guilt.  Defendants are presumed to be innocent, unless and until proven guilty.

The public is encouraged to report suspected instances of health care fraud to the HHS OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477) or https://oig.hhs.gov/fraud/report-fraud/index.asp

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