Miami Woman Sentenced to Prison, Ordered to Repay $33 Million for Role in Schemes to Facilitate Government Fraud
A Miami woman was sentenced today to 48 months in prison and was ordered to pay more than $33 million in restitution for her role in various schemes to defraud the Social Security Administration (SSA) and other government agencies.
Maritza Exposito, 57, of Miami, was sentenced in U.S. District Court, Southern District of Florida, based on her guilty plea to Conspiracy to Commit Healthcare Fraud and Wire Fraud on March 7, 2016. In addition to the prison term, Exposito was sentenced to three years’ supervised release and ordered to pay restitution of $16.7 million to SSA; $7.2 million to the Department of Health and Human Services (HHS); $9.5 million to the State of Florida; and $116,000 to the U.S. Citizenship and Immigration Services (USCIS).
A multi-agency investigation revealed that a Miami psychiatrist—Fernando Mendez-Villamil, 48, of South Miami—and three co-conspirators—Exposito, Arnaldo Oscar Jimenez, 57, of Hialeah, and Yomara Vila, 45, of Miami—perpetrated a scheme that spanned 14 years. The group conspired to provide fraudulent medical information in support of false Social Security disability applications, false Medicare and Medicaid claims, and false statements with respect to immigration benefits.
According to the investigation, from 2002 through early 2016, Mendez-Villamil charged people $1,500 cash for false mental diagnoses. In some cases, he also backdated records to present an extended period of mental impairment. As part of the scheme, he provided sample patient progress notes to his co-conspirators and gave instructions for cloning and falsifying records. They then would forward the false medical records to SSA to support the medical diagnoses for the fraudulent disability claims. Since 2009, Mendez-Villamil said he provided medical evidence for over 3,000 disability applicants.
“The Social Security OIG is committed to pursuing fraud facilitators who violate the public trust by deception and exploit Social Security’s programs and benefits for their personal gain,” said Margaret M. Jackson, Special Agent-in-Charge of the SSA OIG’s Atlanta Field Division. “As this investigation demonstrates, we are committed to working with other law enforcement agencies to combat fraud and protect the integrity of Social Security’s and related agencies’ benefit programs.”
The investigation revealed that the conspiracy involved:
- falsely billing Medicare and Medicaid for patient encounters that did not occur;
- providing false diagnoses of psychiatric impairments to support Social Security disability claims;
- falsely certifying diagnoses of psychiatric impairments on U.S. Citizenship and Immigration Services (USCIS) Form N-648 so that persons applying for naturalization were fraudulently exempted from the examination requirement in civics and language; and
- prescribing medicine that was not medically necessary to Medicaid and Medicare beneficiaries.
On January 7, 2016, a Federal Grand Jury in the Southern District of Florida indicted Exposito, Vila, Mendez-Villamil, and Jimenez on several charges: Conspiracy to Commit Wire Fraud and Healthcare Fraud, Healthcare Fraud, Conspiracy to Defraud the United States, Conspiracy to Defraud the Government with Respect to Claims, Theft of Government Funds, Social Security Fraud, and Fraud and Misuse of Visas, Permits, and other Documents.
On May 10, 2016, a judge sentenced Vila to 33 months in prison and three years’ supervised release and ordered her to pay restitution of $119,360 to SSA, $267,266 to the State of Florida, and $116,000 to USCIS. Vila’s sentencing was based on her guilty plea to Conspiracy to Commit Healthcare Fraud and Wire Fraud on March 1, 2016.
Also on May 10, 2016, Mendez-Villamil pled guilty to Conspiracy to Commit Healthcare Fraud and Wire Fraud; Conspiracy to Defraud the U.S. Government and Make False Statements with Respect to Immigration; and Conspiracy to Defraud the U.S. Government with Respect to Claims. He is scheduled to be sentenced on July 22, 2016.
Jimenez is scheduled for trial in July 2016.
The OIG conducted this investigation jointly with the U.S. Attorney’s Office, Southern District of Florida, the FBI, the U.S. Department of Health and Human Service OIG, Homeland Security Investigations, and the Florida Medicaid Fraud Control Unit.https://oig-files.ssa.gov/audits/full/Exposito%20May%2013%20Release_0.pdf