Puerto Rico Physician Sentenced For Role in Fraud Scheme
February 05, 2021
FOR IMMEDIATE RELEASE
February 5, 2021
The Inspector General for the Social Security Administration (SSA), Gail S. Ennis, announced the sentencing of Dr. Americo Oms-Rivera today for his role in a widespread Social Security disability fraud scheme in Puerto Rico. Oms-Rivera pleaded guilty in October 2020 to conspiracy to commit wire fraud, and was sentenced today to 5 years of probation. He will also pay restitution of $321,000 to SSA and forfeit a property he owns.
According to the plea agreement, Oms-Rivera admitted that from 2009 to 2015, he and other co-conspirators knowingly devised a scheme to defraud SSA, and obtain money and property by false and fraudulent means and pretenses. As part of the scheme, Oms-Rivera would submit false medical documents to SSA for patients applying for Disability Insurance benefits. The documents purported that the patient was suffering from disabling psychiatric conditions and unable to work.
Moreover, Oms-Rivera backdated medical records, creating fictitious medical appointments to present a longer history of treatments. Oms-Rivera would refer patients to a conspirator in order for that conspirator to assist them in applying for Social Security Disability Insurance benefits. That conspirator, a non-attorney representative and former SSA employee, then coached claimants on how to complete forms and what to say to those involved in making the disability determination.
The plea agreement stipulates that Oms-Rivera will forfeit a property in Humacao, Puerto Rico, pay a fine of $7,500, and surrender his DEA license. He will also be prohibited from participating in SSA cases as well as in cases involving Medicare, Medicaid, and all other Federal health care programs. Two other co-conspirators involved in the scheme pleaded guilty in March 2017. A third co-conspirator pleaded guilty in March 2020.
“This sentence reflects years of work by our investigators, and the U.S. Attorney’s Office, to stop this scheme to defraud taxpayers, and hold accountable those responsible,” said Inspector General Ennis. “We will continue to uphold the integrity of SSA’s disability programs by aggressively pursuing facilitators in the claims process who abuse the trust placed in them.”
“Social Security has a robust fraud detection and referral process. The process worked--it was the diligent employees of the Puerto Rico Disability Determination Service (DDS, funded and trained by Social Security to make medical determinations) who first identified the criminal actions of the doctors involved. The DDS employees suspected fraudulent medical evidence was being submitted and referred the fraud allegation to Social Security, who referred it along with information about the non-attorney representative to OIG for investigation,” said Andrew Saul, Commissioner of Social Security.
This case was investigated by the SSA OIG’s Cooperative Disability Investigations unit in Puerto Rico, under the supervision of New York Field Division Special Agent-in-Charge John F. Grasso. The Puerto Rico Police Department, Drug Enforcement Administration, Health and Human Services OIG, and FBI provided invaluable assistance in the investigation.
Inspector General Ennis thanked our law enforcement partners, the U.S. Attorney’s Office, and Special Assistant United States Attorney Vanessa D. Bonano-Rodríguez, for their efforts leading to today’s sentencing.
Members of the press may make inquiries to Social Security OIG at oig.dcom@ssa.gov or (410) 965-2671.