Puerto Rico Doctor, Three Others Indicted for Social Security Disability Fraud Scheme

August 04, 2016

From the U.S. Attorney’s Office, District of Puerto Rico:

SAN JUAN, P.R. - On August 2, 2016 a Federal Grand Jury in the District of Puerto Rico returned a 16-count indictment charging one doctor, Americo Oms-Rivera, his secretary Mayte González Muñoz, and Francisco Cabrera Alvarado, a former Social Security Administration (SSA) employee, for fraud in the application process for SSA disability insurance benefits in Puerto Rico, announced United States Attorney for the District of Puerto Rico, Rosa Emilia Rodríguez Vélez.

Defendants are also facing charges for wire fraud, false statement or representation to SSA, dispensing controlled substances by a practitioner (diversion), health care fraud, and aggravated identity theft.

SSA is responsible for the implementation of the Disability Insurance program. SSA provides monetary benefits to workers with severe, long-term disabilities, who have worked in SSA-covered employment for a required length of time. Spouses and dependent children of disabled workers may also be eligible to receive benefits.

Pursuant to SSA regulations, a claimant must prove to SSA that he or she is disabled by furnishing medical and other evidence with the application. The application and supporting evidence is then evaluated by SSA to determine the individual’s medical impairments and determine the effect of the impairment on the claimant’s ability to work on a sustained basis.

The indictment alleges that on or about September 24, 2013, Person A was introduced to Oms-Rivera to discuss his intentions of applying for disability insurance benefits. During said meeting, Oms-Rivera informed Person A that he/she needed to seek treatment for a period of five to six months before the paperwork was submitted to SSA. Oms-Rivera told Person A that once Person A’s disability benefits were approved, he would take a percentage of the check as payment. The scheme involved, among others, the following acts alleged in the indictment:

On or about January 14, 2014, Person A had the first medical appointment with Oms-Rivera. During this visit, Person A informed the doctor that he/she was interested in obtaining SSA disability insurance benefits. Person A reported that his/her medical conditions were high blood pressure and migraines from time to time. In response, Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for depression and panic disorders and Restoril, a Scheduled IV narcotic used to treat insomnia symptoms.
Person A made additional visits to Oms-Rivera for purported medical treatment. During these visits, Oms-Rivera and Person A discussed the disability application process and Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for depression and panic disorders; Restoril, a Scheduled IV narcotic, used to treat insomnia symptoms; Ambien, a Scheduled IV narcotic, used to treat insomnia; and Xanax, a Scheduled IV narcotic, used to treat anxiety and panic disorders.
Oms-Rivera and defendant González-Muñoz referred Person A to Cabrera, a former SSA employee who worked as a non-attorney representative. Cabrera assisted Person A in his application for SSA disability insurance benefits.
On May 21, 2014, Cabrera met with Person A in order to assist him/her to fill out the Adult Function Report, SSA Form 3373. During said meeting, Cabrera coached Person A as to what to write in the form in order to get Person A’s disability benefits approved.
On June 10, 2014, González charged Person A $600 for the Psychiatric Medical Report and $1,440 for backdating his/her medical file and creating 24 fictitious medical appointments.
On or about October 22, 2015, the Psychiatric Medical Report signed by Oms-Rivera was submitted to SSA indicating that Person A was totally disabled to return to work as of that date or in the near future. In the Psychiatric Medical Report, Oms-Rivera falsely represented to SSA that Person A’s first medical visit was on October 15, 2013. Oms-Rivera further reported a total of approximately 11 fictitious appointments that never took place. This was done to create the appearance of a longer history of medical treatment.

The government is seeking the forfeiture of the medical license of Oms-Rivera since he used it to facilitate the commission of controlled substances offenses when he prescribed or dispensed controlled substances outside the scope of his medical practice. The defendants are facing a maximum penalty of 5 years in prison for the conspiracy to defraud the United States; up to 20 years in prison for wire fraud; up to 5 years in prison for providing false statements to the SSA; up to 20 years for dispensing controlled substances by a practitioner (diversion); 10 years for health care fraud; and a statutory term of two years in prison, consecutive to any other sentence, for the aggravated identity theft charges.

Beneficiary Julio Rodríguez-Ríos was charged in a separate indictment with theft of government property and false statement or representation to SSA. That second indictment alleges that Rodríguez-Ríos provided false statements to SSA, during a Continuing Disability Review, indicating that he had not worked since July 5, 2009, when in fact he had worked after said date. Rodríguez-Ríos is facing a forfeiture allegation of $25,316 in United States currency.

“This is another Social Security Disability Benefits Fraud case where shameless individuals illegally facilitated and obtained the benefits provided by the Federal Government. This is not a victimless crime, but rather an unacceptable act that deprives those who truly need assistance from receiving it,” said United States Attorney Rosa Emilia Rodríguez-Vélez. “The Department of Justice is committed to investigate and prosecute those who engage in fraudulent schemes.”

SSA-OIG Special Agent-in-Charge John Grasso said: “The Social Security Disability Insurance program is intended to support individuals truly in need of this important and earned benefit. The program relies on the truthfulness of disability applicants, as well as other professionals involved in the application process, to include physicians, attorneys, and non-attorney representatives. It is particularly disturbing when people in positions of trust engage in criminal activity that undermines Social Security’s programs and their own professional responsibility. I am very grateful for the efforts of all of our law enforcement partners involved in this investigation, and for the continued commitment from the United States Attorney’s Office for the Commonwealth of Puerto Rico to aggressively pursue these important cases. I strongly encourage the public to report suspected instances of Social Security fraud to the OIG’s Fraud Hotline at 1-800-269-0271 or https://oig.ssa.gov/report.”

The case was investigated by the Social Security-OIG with the collaboration of the FBI, DEA, Health and Human Services, and the Puerto Rico Police Department. The case was indicted by Special Assistant United States Attorney Vanessa D. Bonano-Rodríguez.

On or about January 14, 2014, Person A had the first medical appointment with Oms-Rivera. During this visit, Person A informed the doctor that he/she was interested in obtaining SSA disability insurance benefits. Person A reported that his/her medical conditions were high blood pressure and migraines from time to time. In response, Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for depression and panic disorders and Restoril, a Scheduled IV narcotic used to treat insomnia symptoms.
Person A made additional visits to Oms-Rivera for purported medical treatment. During these visits, Oms-Rivera and Person A discussed the disability application process and Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for depression and panic disorders; Restoril, a Scheduled IV narcotic, used to treat insomnia symptoms; Ambien, a Scheduled IV narcotic, used to treat insomnia; and Xanax, a Scheduled IV narcotic, used to treat anxiety and panic disorders.
Oms-Rivera and defendant González-Muñoz referred Person A to Cabrera, a former SSA employee who worked as a non-attorney representative. Cabrera assisted Person A in his application for SSA disability insurance benefits.
On May 21, 2014, Cabrera met with Person A in order to assist him/her to fill out the Adult Function Report, SSA Form 3373. During said meeting, Cabrera coached Person A as to what to write in the form in order to get Person A’s disability benefits approved.
On June 10, 2014, González charged Person A $600 for the Psychiatric Medical Report and $1,440 for backdating his/her medical file and creating 24 fictitious medical appointments.
On or about October 22, 2015, the Psychiatric Medical Report signed by Oms-Rivera was submitted to SSA indicating that Person A was totally disabled to return to work as of that date or in the near future. In the Psychiatric Medical Report, Oms-Rivera falsely represented to SSA that Person A’s first medical visit was on October 15, 2013. Oms-Rivera further reported a total of approximately 11 fictitious appointments that never took place. This was done to create the appearance of a longer history of medical treatment.