Business Owner And His Wife Sentenced For Health Care Fraud

SAN JUAN, P.R. – On June 17, 2013 defendant Gilberto Gómez was sentenced to a term of imprisonment of 70 months and ordered to pay restitution in the amount of $1,956,750.54 by US District Court Judge Gustavo A. Gelpí, announced Rosa Emilia Rodríguez-Vélez, United States Attorney for the District of Puerto Rico.  Today, his wife Yolanda García was sentenced to a term of imprisonment of 12 months and a day, followed by 2 years of Supervised Release Term and a Special Monetary Assessment in the amount of $100.00.

A forfeiture order was also issued for the seizure of all the properties and monies mentioned in the forfeiture allegation of the Indictment, which include a luxurious apartment at Gallery Plaza Condominium in Condado, multiple bank accounts, investment accounts, jewelry and other personal property that constitutes or was derived, directly or indirectly from the gross proceeds traceable to the commission of the offense.

On January 12, 2012, a Federal grand jury returned an indictment against multiple individuals for conspiracy to commit health care fraud. Amongst them,  Gilberto Gómez, president of Monte Mar Health Corporation (Monte Mar), PROMEDS Medical Inc. (PROMEDS) and Quality Care Medical Supply (Quality) and Yolanda García-Rodríguez, aka “Yolanda Gómez,” wife of Gómez and president of PROMEDS, secretary/treasurer of Monte Mar and an authorized official of Quality.

The indictment alleges that from on or about November, 2008, until on or about May, 2010, Monte Mar submitted at least 1,518 false and fraudulent claims to Medicare totaling approximately $2,993,127.35 for Durable Medical Equipment (DME) that was not medically necessary, causing Medicare to disburse approximately $1,440,597.65.  The indictment further alleges that on or about March 2010, after Monte Mar had been placed in a pre-payment status by Medicare, defendants Gilberto Gómez and Yolanda García-Rodríguez purchased PROMEDS and submitted false claims to Medicare seeking reimbursement for DME, including power wheelchairs, power pressure reducing air mattresses and knee orthosis.  PROMEDS submitted at least 359 fraudulent claims to Medicare totaling approximately $786,368.34, causing Medicare to disburse approximately $335,493.12.

The indictment further alleges that in October 2010, a third company, Quality, was purchased by Gómez and García-Rodríguez after PROMEDS had been placed in a pre-payment status by Medicare.  From on or about October 2010, until May, 2011, Quality submitted at least 115 false claims to Medicare totaling approximately $298,321.26, causing Medicare to disburse approximately $180,659.77.  The indictment alleges a total amount of $4,077,816.95 fraudulently billed by using Monte Mar, PROMEDS and Quality, where Medicare disbursed a total of approximately $1,956,750.54.

The investigation was led by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), with the collaboration of the United States Secret Service (USSS) and the Federal Bureau of Investigation (FBI).

“As part of the nation’s health care system, Medicare serves vulnerable populations,” said United States Attorney, Rosa Emilia Rodríguez-Vélez.  “The sentences imposed by the Court today show that we will not tolerate criminals who engage in fraudulent schemes which deplete the Medicare program of funds which are destined for our elderly population, in order to enrich themselves.”

“HHS/OIG works diligently to investigate allegations of Medicare fraud. Today's sentencings involving Durable Medical Equipment (DME) fraud demonstrate our resolve to bring these subjects to justice. Furthermore, our efforts, along with the US Attorney's Office and our Law Enforcement partners, have made a dramatic reduction on the total dollars billed and paid for DME in Puerto Rico.”
“The U.S. Secret Service is committed to investigate any financial fraud crimes to include identity theft along with our partner agencies to safeguard our financial system,” said Pedro Gómez, Special Agent in Charge.  We will continue to investigate these types of crimes to the fullest extent of the law and bring to justice these criminals that engage in identity theft to facilitate other criminal activities.”
The case was prosecuted by Assistant U.S. Attorney Héctor Ramírez-Carbó and Special Assistant U.S. Attorney Wallace A. Bustelo.