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Doctor Brothers José and Carlos López-Díaz
Guilty Of Health Care Fraud

For Immediate Release
June 14, 2012

U.S. Attorney's Office
District of Puerto Rico News Release

SAN JUAN, P.R. - Today, after a one-month trial before District Court Judge Francisco A. Besosa, general practitioner José López-Díaz and his brother, dentist Carlos López-Díaz, were found guilty of conspiracy to commit health care fraud, announced United States Attorney for the District of Puerto Rico, Rosa Emilia Rodríguez-Vélez. They were also found guilty of five counts of aggravated identity theft that are among the 35 counts included in the superseding indictment filed on December, 2011. José López-Díaz was also found guilty of all substantive health care fraud counts charged in the indictment.

Doctor José López-Díaz and his brother Doctor Carlos López-Díaz were arrested on September 1, 2011, after a Federal grand jury returned 35-count indictment for conspiracy to commit health care fraud and a forfeiture allegation of $727,729.16. The investigation was lead 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).

According to the indictment, José López-Díaz a general practitioner licensed to practice medicine in Puerto Rico, was billing for Medicare services not rendered. The services billed and not rendered included: billing Medicare for 10,231 claims for medical treatment allegedly provided to Medicare patients at Guaynabo Medical Mall's Emergency Room, even though he had never worked at such institution and never saw the patients; billing of Medicare code 53085, known as "Drainage Perineal Urinary Extravasation", a procedure which was allegedly performed by José López-Díaz on female patients, when this procedure can only be performed on male patients. José López-Díaz never provided medical treatment to the Medicare beneficiaries whose identities he used in order to bill Medicare.

Over the period of time referred to in the Indictment, José López-Díaz fraudulently billed Medicare for $3,591,298.90 and received the amount of $727,729.16 in Medicare reimbursements.

Doctor Carlos López-Díazis a licensed dentist in Puerto Rico and the brother of José López-Díaz. Over the course of the health care fraud scheme, Carlos López-Díaz conspired with his brother to defraud Medicare and provided him with names and Medicare beneficiary numbers of patients treated by Carlos López-Díaz at his dental clinic in order for his brother to bill Medicare for services not rendered to those patients.

"We are pleased with the convictions of these two defendants," said United States Attorney, Rosa Emilia Rodríguez-Vélez. "Today's convictions 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. "We will continue prosecuting individuals who engage in this type of fraud to the full extent of the law."

"We are proud to be a part of the federal team that brought these defendants to justice for defrauding the Medicare program and exploiting the elderly," said Thomas O'Donnell, Special Agent in Charge of the Office of Inspector General's New York Regional Office which also covers Puerto Rico. "Arresting owners and providers, freezing their assets and prosecuting them to the fullest extent possible, are some of the tools that the federal government has available, and will be utilized to remove these individuals from participating in the Medicare program."

"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."

HHS-OIG, USSS and the FBI, the investigative agencies received substantial collaboration from the Special Investigative & Compliance Units from Medical Card System Inc., Triple-S Salud, Medicare y Mucho Más and Preferred Medicare Choice.

The case was prosecuted by Assistant U.S. Attorney Ernesto López-Soltero, White Collar Unit Chief and Special Assistant US Attorney Wallace A. Bustelo. The defendants could face a possible sentence of twenty (20) years in prison.


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