Fraud’s Fast Track to Prison

happiness mechanic on a garage

People need to have confidence in their healthcare providers and in the government programs that help cover their healthcare costs. That was the message from a federal judge when he sentenced a San Antonio man to seven years in federal prison for his role in a multimillion-dollar healthcare fraud scheme aimed at the federal workers’ compensation program.

The Texan was the owner of a company that provided physical therapy and rehabilitation services at multiple locations in San Antonio and Salt Lake City. The evidence in today’s case showed that between 2012 and 2016, the man schemed to defraud the Federal Employees Compensation Act (FECA) and the Office of Workers Compensation Program, a Department of Labor program that serves federal employees.

The man from San Antonio billed the federal workers’ compensation program for physical therapy services he claimed were provided by qualified professionals. (The services were actually provided by unlicensed technicians. That’s definitely not a good way to save on costs.)

In addition, it’s important to note that the business owner used the identity of a physical therapist without their permission to register as a provider in the program. (Now he’s adding identity fraud to the mix). He billed the program for $7.5 million over four years and was paid more than $6 million for fraudulent claims.

The 49-year-old man from San Antonio is headed to prison and will have to pay more than $6 million back to the government for committing workers’ compensation fraud. (As the judge said, fraud isn’t just about stealing money from government programs, it also erodes trust in the programs and providers.)

Today’s Fraud of the Day comes from the U.S. Department of Justice press release, “Judge Sentences San Antonio Businessman to Federal Prison for Health Care Fraud Scheme,” released Dec. 2, 2019.

In San Antonio today, a federal judge sentenced 49–year-old San Antonio businessman Rafael Enrique Rodriguez to seven (7) years in federal prison for his role in a multi-million-dollar health care fraud scheme.

In addition to the prison term, Senior U.S. District Judge David A. Ezra ordered that Rodriguez pay $6,032,126.69 in restitution to the government and be placed on supervised release for a period of three (3) years after completing his prison term.  Judge Ezra ordered that Rodriguez surrender to federal authorities on January 16, 2020, to begin serving his federal prison term.

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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.