The latest in Medicare scams: Services provided, but in Nicaragua

Note to Healthcare providers. It can create liability if you provide your services in another country while claiming to provide those services in the United States.

This may seem obvious, but apparently it was not so obvious to Dr. Santiago B. Montoya and his son Rodney. Dr. Montoya is going to serve a four year prison sentence.

The Montoyas ran a health clinic in Managua, the capital of Nicaragua. They worked with Florida Health Care Plus, which had 1,000 Miami area expatriate patients enrolled and claimed to provide healthcare services to the patients under Medicare Advantage plans.

According to the Miami Herald:

The scheme without borders broke Medicare laws because the federal insurance program for the elderly and disabled does not allow coverage of beneficiaries’ claims if they are receiving the services in a foreign country.

DC Whistleblower Lawyer Tony Munter mused, “The Miami Herald Article makes me want to know so much more. I have so many questions, like how did the government learn about this? Is a whistleblower responsible, and if so, did that whistleblower get any kind of reward for shutting down this scam?”

It says something about the state of health care fraud in the U.S. that the Judge felt it necessary to be slightly lenient to the Montoya’s on the theory that at least they actually provided some healthcare, even if that care was in Nicaragua and not in Miami. The scam even extended to include a clinic in the Dominican Republic.

It’s a little unusual for cases involving Medicare fraud to involve prison sentences for the people committing the fraud, but nonetheless, the Department of Justice has the authority to prosecute individuals as criminals.

The Herald Reported that the company funding these operations received about $10.5 million in government payments for illegally treating the beneficiaries in Nicaragua and the Dominican Republic.