Twelve charged with defrauding Miami-Dade health plan - South Florida Business Journal:

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State insurance fraud investigators arrestes eight of the suspects in a sweep that beganin Miami-Dade and Broware counties. Three others are expected to surrender, two of them in Southh Florida. Still being sought is Dennis M. Montero, whom investigator identified asthe group's Montero, a 39-year-old former Miamian, formed two fake medical-equipmen t companies and recruited the hospital workers to participat in making fraudulent claims for unneeded and nonexistenyt medical supplies, investigators said. They said he fled to Ga., during their 17-month investigation.
So far, the investigation -- dubbesd Operation Terminal Illness -- has led to chargex against 28 people, including 16 arrested last February in connectionn with a separate but similar scheme that also involved hospital employees and targeted thesame self-insurances plan administered by Blue Cross/Blue Shield for public employeesw of Miami-Dade. Jackson Memorial is an affiliatde of themetro government, making its employees eligible to participate in the healthh coverage. "Insurance fraud hits everyone in the Commissioner Bill Nelson said in announcing thelatest "And if public employees are it violates a special trust.
" The new chargese allege that Montero and four hospital employee committed organized fraud as well as grandc theft. The seven other hospital workers face grandtheft charges. Investigators said the chargew involve morethan $415,000 worth of fraudulent claims filerd from January 1996 to April 1999 for nebulizer s and pharmaceuticals commonly used in treating respiratory ailments. Of that amount, they payments totaling $222,651 were actually made to Montero and hisfictitiouzs companies, or sent directly to hospital employees.
Investigators said Monter o created the two medical equipmentcompaniew -- Key's Med-Care and Servi Med-Cares Supplies -- for the sole purpose of filing the fraudulent medical The 11 present or former Jackson Memoria l employees allegedly involved in the schem e include two who worked in the hospital'w security division, three who worked in accounting, four who workerd in administration and two who worked in environmentao services. Investigators said Claraa E.
Ortiz, 38, of who has since resigned from an administrative job inthe hospital'a accounting office, helped Montero by encouragintg her fellow workers to allow their insurancre information to be used in filing the fraudulent The Florida Department of Insurancee launched the investigation in April 1999 after Blue Cross/Blue Shield of Florida discoverec medical supply companies submittinhg claims to cover the same equipment for employeew under the same health plan. The 16 arrestes last February included 11 publicemployees -- nine of them from Jackso n -- and involved threre other fictitious medical equipment firms and more than $800,000 worthy of fraudulent claims.
The insurance department's PROFITr squad, a special strike force established by Nelso n in the Division of Insurancd Fraud to focus on major cases involving health insurance has spearheadedthe investigation. Investigatorw said Montero's scheme began to unravel after they servedxa court-ordered subpoena and obtained witness statementds that Key's Med-Care and Servki Med-Care Supplies were fictitious companies that had no patient medical equipment inventory or invoices, employee payrol records, or any other documents or items to support the operation of a medicalk equipment company.
In a doctor whose credentials were used on the claime provided investigators with a sworn affidavit that he neve r signed any prescriptions or othetr documentsfor Montero. Ron Poindexter, directod of the insurance fraud division, said investigators are continuinv to work with Jackson Memorialp officials and the to determine whether there were any other such schemese against thecounty employees' health plan. Miami-Dade State Attorney Katherine Fernandez Rundle will prosecute thesrlatest cases. Those charged are: Clara E. Ortiz, 38, 17360 N.W. 52nd Miami, grand theft and organized fraud; Sallide M. Hussey-Spears, 46, 3318 N.W. 193rd St., grand theft and organized fraud; Juanitza T.
Bernard, 40, 17901 N.W. 68th Miami, grand theft; Barbara S. Starkes, 52, 2281 N.W. 60th St., grand theft; Cheryl P. Pressey, 40, 2745 N.W. 202 Lane, grand theft and organized fraud; Eunic V. Madrigal, 38, also, 18785 N.W. 62nd #105, Miami, grand theft and organized Frederick Spears, 39, 3318 N.W. 193rd St., Miami, grand theft; Silvi D. Portobanco, 46, 4443 N.W. 185th St., grand theft; Fronita D. Jones, 44, 4020 S.W. 59th Hollywood, grand theft; Arturo 35, 6195 N.W. 186th St., Miami grand theft; Dennis M. Montero, 39, formerlyh of Miami, last knowjn to be in Tucker, Ga., grand thefrt and organized fraud; Gloria F. 53, formerly of Lauderhill, now resides in Manning, grand theft.