Two Miami residents, Jorge Perez and Ricardo Perez, were sentenced Dec. 15 for their roles in a multi-state scheme to defraud insurers by using rural hospitals to bill for urine drug testing.
Jorge Perez, who owned and managed hospitals as well as a billing company, and Ricardo Perez, who managed a billing company, illegally billed for lab tests that were not medically necessary and fraudulently billed through rural hospitals in Florida and Missouri rather than the independent labs where much of the testing was done, according to court documents.
Prosecutors said the individuals gained control over financially distressed rural hospitals and used them for billing to take advantage of private insurance contracts that provided higher reimbursement rates for these hospitals than for out-of-network labs. The claims were submitted to falsely appear that the hospitals did the lab tests, but most of the services were provided by labs controlled by others, including a co-conspirator.
The rural hospitals involved in the case were:
- Graceville, Fla.-based Campbellton-Graceville Hospital, which declared bankruptcy in 2017
- Regional General Hospital Williston (Fla.), which has closed
- Putnam County Memorial Hospital in Unionville, Mo.
Jorge Perez was sentenced to eight years and four months in prison. Ricardo Perez was sentenced to six years and three months in prison.