Phony Claims Submitted to Wife’s Insurance Carrier
WASHINGTON—Luis Rodriguez, 46, of Bethesda, Maryland, a contractor with the Federal Aviation Administration, pled guilty today to a federal charge stemming from the submission of false health care claims, announced U.S. Attorney Ronald C. Machen, Jr. and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office.
Rodriguez pleaded guilty in the U.S. District Court for the District of Columbia to one count of health care fraud. In this case, the charge carries a statutory maximum of 10 years in prison and potential fines. Judge Richard W. Roberts scheduled sentencing for September 25, 2012.
According to a statement of offense signed by the defendant as well as the government, Rodriguez is a Spanish national who is in the United States on a G-4 work visa, due to his wife’s employment with the Inter-American Development Bank (IDB). The IDB is an international financial institution established in 1959 by the Organization of American States and maintains its principal offices in Washington, D.C. The IDB is the largest source of development financing for Latin America and the Caribbean and is funded by its 48 member countries, including the United States, which holds 30.01 percent of the IDB’s shares and is the largest shareholder. The U.S. Secretary of the Treasury serves on the bank’s Board of Governors.
The IDB offers health insurance to all of its staff members and their eligible dependents. IDB’s health insurance plan is administered by CIGNA. Persons covered under the plan may pay their doctors or medical providers out-of-pocket and then submit claims for reimbursement to the IDB through CIGNA.
From March 2006 through April 2010, Rodriguez submitted approximately 2,800 reimbursement claim forms to CIGNA, identifying over 25,000 individual services such as physical therapy that Rodriguez claimed had been provided to him or his two minor children. The bills submitted by Rodriguez totaled more than $1.3 million.
In fact, all of those claims were false; none of the claimed services had ever been provided. Based on the submission of false claims, CIGNA sent checks to Rodriguez for more than $1.25 million. Because the fraud was discovered in time to stop payment on some of the checks, the IDB’s actual loss was just over $1,014,475.
When Rodriguez realized federal authorities were investigating his fraud scheme, he devised a plan to obstruct the federal investigation. Rodriguez attempted to impersonate a senior IDB official and ordered CIGNA to tell the FBI to close the investigation without further action.
“Health care fraud is a growing scourge on our nation. Whether the victim is a private entity like the Inter-American Development Bank—which is partially funded by the American taxpayer—or a government-funded program like Medicare or Medicaid, health care fraud increases the costs of medical care for everyone and diverts resources away from those who truly need it,” said U.S. Attorney Machen. “This prosecution is one of many that demonstrates our commitment to holding accountable those who would steal from the health care system for their own personal profit.”
“Mr. Rodriguez stole more than $1 million through insurance claims for services he did not receive,” said Assistant Director in Charge McJunkin. “Today’s plea demonstrates that the FBI will pursue all such fraudulent schemes which damage the ability of health care providers, employers, and patients to participate in a system free of fraud and dishonesty.”
In announcing the plea, U.S. Attorney Machen and Assistant Director in Charge McJunkin praised the special agents who investigated the case from the FBI’s Washington Field Office. They also expressed appreciation for the assistance provided by the IDB and CIGNA. Finally, they acknowledged the efforts of those who worked on the case from the U.S. Attorney’s Office, including Legal Assistant Nicole Wattelet and Assistant U.S. Attorney Ted L. Radway, who is prosecuting the matter.