A pair of Westchester residents are facing criminal charges for their roles in a multi-million dollar Medicaid scheme.
Yonkers residents Jorgelina Abreu Gil, 32, the owner of KJ Transportation C Services Inc., and her husband, Julio Alvarado, 59, the manager of the company, were among 13 charged with participating in a scheme to steal millions of dollars from New York State Medicaid program by making fraudulent claims related to transportation services.
U.S. Attorney Geoffrey Berman said that beginning in 2017, KJ began submitting claims to Medicaid for purported medical transportation services for eligible people in New York. From August 2017 to February this year, KJ submitted more than 100,000 claims related to hundreds of thousands of trips.
Berman said that in truth, a large percentage of those claims were fraudulent. In some instances, the Medicaid recipient was dead or out of the country when KJ claimed it was transporting that person to medical appointments. In other instances, the Medicaid recipient had never heard of KJ and had never taken any rides with the company. In other instances, the Medicaid recipient had received kickbacks from the fraudsters in exchange for either giving KJ Medicaid information or for fraudulently scheduling trips weren’t taken.
In total, the scheme led to KJ receiving more than $20 million from Medicaid.
“As alleged, these defendants exploited and abused Medicaid, billing millions of dollars for phantom medical transportation services,” Berman said. “Medicaid is intended to provide financial assistance to those in need. These defendants allegedly treated the Medicaid program that pays for medical transport as an opportunity to steal from Medicaid, which is indirectly stealing from American taxpayers. Now they face prosecution for their alleged crimes.”
Others charged are Bronx residents Jose Rivera, 26, Fabian Morgan, 39, Victoria Palma Brea, 32, Christopher Santos Felix, 28, John Manuel Mejia, 41, Jose Jimenz Hidalgo, 42, Francisco Salazar, 68, and Nelson Diaz, who acted as “drivers” or “recruiters” of Medicaid enrollees.
“It is alleged that these individuals schemed to defraud the Medicaid program out of millions of dollars, in turn robbing all those who rely on it for their vital healthcare needs,” Homeland Security Special Agent in Charge Peter Fitzhugh added. “More than a dozen were involved in this plan to charge for services not rendered, and HSI working with its law enforcement partners arrested those who sought to make a profit at the expense of those in need and will continue to do so.”
Each of the suspects were arrested and charged with one count each of submitting false claims, theft of government funds, wire fraud, health care fraud, conspiracy to commit wire fraud and health care fraud, and violating the Anti-Kickback Statute. Abreu Gil and Alvarado were also charged with one count of money laundering.
If convicted, they will face decades in prison. No return court date has been announced.
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