By james art Jose Davila NunesA 51-year-old Miami businessman received a federal sentence of 63 months in prison on Oct. 11, followed by three years of supervised release, for his role in a Medicaid fraud scheme. He was also ordered to pay $3,869,703 in restitution. Dávila pleaded guilty on June 14 to conspiracy to commit health care fraud.
According to court documents and an agreed statement of facts, Dávila and his co-conspirators set up a mental health clinic called New Behavior Health Direction, Incorporated (New Behavior) in Hialeah Gardens, Florida, using a fake owner as a front. Between April 2019 and September 2020, they submitted false claims to Medicaid totaling $3,869,703 to provide psychosocial rehabilitation (PSR) services, a type of therapy designed to help individuals with disorders such as depression and anxiety. In September 2020, the fictitious owner cashed in the fraudulent proceeds, shared a portion with Dávila, and then fled to Cuba. Dávila’s company, Max Medical Consulting Services, Incorporated, based in Miami, received approximately $500,000 in fraudulent income generated by New Behavior.
Additional fraud and its consequences
During the sentencing hearing, Dávila was also charged with an additional $2,617,992 in fraud related to bribes he and his partners paid to patients between November 2018 and December 2022. Those bribes were in exchange for receiving of PSR services at three other Miami clinics: Davila Medical Center, Incorporated, Advanced Community Wellness Center, and Larkin Behavior Health, Incorporated. The US government was able to seize approximately $1.7 million in cash linked to New Behavior’s bank accounts.
Widespread fraud in South Florida
This case adds to a growing list of fraudulent activities in South Florida, many involving Cuban nationals or individuals connected to the island. The region has been a hotspot for various health care fraud schemes, particularly targeting Medicaid and Medicare, prompting authorities to increase their efforts to combat these criminal activities.
On April 1, 2024, Ariel Nunes Finalet, a Cuban national, was convicted in Miami of defrauding Medicare of nearly $17 million. Nunes had been a fugitive for a decade, part of a ring that filed fraudulent claims for unnecessary drugs through Florida pharmacies. Subsequently, on April 3, 2024, Lysandra Santana, a young woman from Hialeah, was charged with faking an accident to claim insurance and treatments by faking injuries to get money. Police discovered that she had deliberately deployed her car’s airbag to make the hoax believable.
Recent fraudulent activities
In early May, two Cuban women, Maria Campos and Isabella Mendez, were arrested for staging a fake car accident in Miami to file fraudulent medical claims exceeding $35,000. A day later, on May 2, 2024, Cristal Arbona, another young Cuban woman, was charged with orchestrating a $40,000 insurance fraud after a traffic accident in Miami. Investigations revealed that the claimed therapies were never administered.
On July 2, 2024, authorities arrested Margelis Moreira Pino, a Cuban national in Miami-Dade, for bribing patients to claim non-existent medical services on Medicare, resulting in over $100,000 in fraudulent claims. Finally, on July 23, 2024, another Cuban in Miami, Agustín García Marsán, was arrested for defrauding elderly people in a grandparent scam, defrauding them of thousands of dollars.