By james art Jose Dávila Nunez, a 51-year-old businessman living in Miami, was sentenced Oct. 11 to 63 months in federal prison, followed by three years of supervised release, for his involvement in a Medicaid fraud scheme. Dávila 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 the agreed statement of facts, Dávila and his co-conspirators opened 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, claiming they provided psychosocial rehabilitation (PSR) services, a type of therapy aimed at helping people with disorders such as depression and anxiety. In September 2020, the fake owner withdrew the fraudulent proceeds, gave some of the money to Davila, and then fled to Cuba. Dávila’s company, Max Medical Consulting Services, Incorporated, located in Miami, received approximately $500,000 in fraudulent income generated by New Behavior.
During the sentencing hearing, Dávila was also charged with an additional $2,617,992 in fraud. This amount is related to bribes he and his accomplices paid to patients between November 2018 and December 2022 in exchange for receiving PSR services at three other Miami clinics: Davila Medical Center, Incorporated, Advanced Community Wellness Center and Larkin Behavior Health United.
The US government was able to seize approximately $1.7 million in cash linked to New Behavior’s bank accounts.
This case adds to a growing list of scams in South Florida, many involving Cuban nationals or people with ties to the island. The region has been the scene of numerous fraudulent schemes related to the health care system, highlighting Medicaid and Medicare fraud in particular, which has led authorities to increase their efforts to combat these criminal activities in the area.
On April 1, 2024, Cuban Ariel Nunes Finalet was sentenced to prison in Miami for defrauding Medicare of nearly $17 million. Nunez was a fugitive for a decade, participating in a ring that filed fraudulent claims for unnecessary drugs through Florida pharmacies.
Subsequently, on April 3, 2024, a young Hialeah woman, Lysandra Santana, was charged with faking an accident to obtain insurance and therapy benefits, faking fake injuries to claim money. Police found that she had broken the car’s airbag herself to make the hoax believable.
In early May, two Cuban women, Maria Campos and Isabella Mendez, were arrested for staging a fake car accident in Miami in order to file fraudulent medical claims for over $35,000. One day later, on May 2, 2024, Crystal Arbona, another young Cuban woman, was charged with running a $40,000 insurance fraud scheme after a car accident in Miami. Investigations revealed that the treatments claimed never took place.
On July 2, 2024, authorities arrested Margelis Moreira Pino, a Cuban woman in Miami-Dade, for bribing patients to request non-existent Medicare medical services. This scheme resulted in over $100,000 in fraudulent claims.
Finally, on July 23, 2024, another Cuban in Miami, Agustin Garcia Marsan, was arrested for defrauding the elderly in a fraud scheme using the “grandparent scam” to obtain thousands of dollars.