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Miami Health Care Fraud Scheme

Vladimir Prado receives an eight year prison sentence for his role in a $10 million health care fraud scheme. The conspiracy includes a now-defunct home health clinic and two bogus physical rehabilitation clinics in Miami, Florida. In addition to the prison sentence, Prado will also serve three years of supervised release and pay $4,001,499 in restitution. Prado’s charges include multiple counts of conspiracy to commit health care fraud and wire fraud.

Prado acknowledges ownership of the Miami medical clinic responsible for falsely billing the Blue Cross Blue Shield more than $5 million in fraudulent claims. Shockingly, the profit to the private medical clinic exceeds $2.5 million.

Prado also admits being the co-owner of a Miami rehabilitation clinic. In the concurrent fraud scheme, Prado and his cronies submit roughly $2.6 million in false and fraudulent claims to Blue Cross Blue Shield. This time, gross profit for the clinic totals around $1.4 million. To further complicate the situation, Prado also admits providing capital to purchase a fraudulent home health agency.

With regard to the home health agency, Prado admits to fraudulent interstate bank wires. In this scenario, Prado and his co-conspirators submit approximately $2.2 million in claims for reimbursement to the Medicare program. The fraudulent claims represent the phony medically necessary home health care benefits prescribed by a doctor, and for Medicare beneficiaries. In reality, however, there are neither medical needs, nor beneficiaries. As a result of the fraudulent claims, Medicare remits payments to the corporate bank accounts of Prado’s home health agency to the tune of approximately $3.9 million.

All-in-all, Prado admits to submitting roughly $7.6 million in fraudulent claims to Florida Blue, along with about $3.9 million in payments from Medicare. As a part of Prado’s fraud plea, he forfeits a myriad of assets, including five homes and high-end jewelry.