Brace for Prison

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Medicare enrollment form and glasses

Patsy “Pat” Joseph Truglia, 53, of Parkland, Fla.,  pleaded guilty to two counts of conspiracy to commit health care fraud and one count of making a false statement in a matter involving a health care benefit program. Truglia faces a maximum penalty of 15 years in federal prison for his crime against Medicare.

Truglia and his cronies, including co-defendant Ruth Bianca Fernandez, produced physicians’ orders via their telemarketing operation for orthotic devices including knee, back, and wrist braces, plus other braces that were considered Durable Medical Equipment (DME). (As you might guess, these braces were medically unnecessary.)

Once the orders for the braces were placed, they were then forwarded to “telemedicine” vendors who paid illegal bribes to physicians to sign orders without ever conducting telehealth consultations for their patients. (Of course, these “telemedicine vendors” also collected a fee for their illegal services. Everybody wants to get in on the “take.”)

The illegal orders were returned to Truglia’s telemarketing operation where co-conspirators  submitted millions of dollars in false and fraudulent claims to Medicare. (That’s how the typical fraudulent billing game goes.)

To avoid a Medicare audit, Truglia and Fernandez spread the fraudulent claims across five DME storefronts that were owned and controlled by Truglia and managed day-to-day by Fernandez. (What a pair those two were.) The fraudulent Medicare scheme caused a loss of approximately $25 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $12 million in payments.

In April 2019, “Operation Brace Yourself” targeted ongoing fraud schemes like Truglia’s that involved paying bribes to get signed doctors’ orders for DME. (I’d like to know how to get a job naming undercover operations. That sounds like fun.) The operation included the execution of search warrants at several of Truglia’s storefronts and a civil action, which prevented Truglia from engaging further in his deceitful crimes.

However, Truglia was not discouraged and continued to operate his scheme until July 2020. He gathered old and new crooks and opened three brand-new DME storefronts and used different “telemedicine” vendors. Truglia and his co-conspirators submitted an additional $12 million in fraudulent DME claims to Medicare, resulting in approximately $6.3 million in payments. (You’d think that after the first search warrant that he would have learned his lesson, but I guess not. He’d better brace for prison.)

Today’s Fraud of the Day comes from an article, “South Florida Man Pleads Guilty To Consecutive Health Care Fraud Conspiracies,” dated October 7, 2021.

Tampa – Tampa, FL – Patsy Truglia (53, Parkland) has pleaded guilty to two counts of conspiracy to commit health care fraud and one count of making a false statement in a matter involving a health care benefit program. He faces a maximum penalty of 15 years in federal prison. A sentencing date has not yet been set.

According to the plea agreement and other court documents, beginning in January 2018 and continuing into April 2019, Truglia and other conspirators, including co-defendant Ruth Bianca Fernandez (who worked under Truglia’s supervision), generated medically unnecessary physicians’ orders via their telemarketing operation for certain orthotic devices—i.e., knee braces, back braces, wrist braces, and other braces—referred to as durable medical equipment (“DME”). Through the telemarketing operation, federal health care program beneficiaries’ (i.e., Medicare beneficiaries’) personal and medical information was harvested to create the unnecessary DME brace orders.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.