Miami PT Clinic Managers Convicted in Insurance Fraud Scheme

A Miami woman now living in North Carolina is awaiting sentencing after she was convicted of paying kickbacks and defrauding insurers of more than $34 million for physical therapy services that were never provided.

A federal jury in Miami last week convicted Jaroslava Ruiz, 50, of health care fraud and wire fraud, the U.S. Department of Justice said. Ruiz, who helped manage four clinics in the Miami area, paid kickbacks and bribes to patient recruiters and to patients with private health insurance. The clinics used the information to bill the insurers, including Blue Cross Blue Shield, Cigna and United Health Group, for services from 2016 to 2020 that were not done, prosecutors said in a news release.

The release did not make it clear if the clinics billed any workers’ compensation carriers. The Raleigh News & Observer newspaper reported that the scheme also filed fraudulent claims with employer-offered Administrative Services Only insurance plans.

“Ruiz and her co-conspirators falsified medical records to give the impression that the physical therapy services were medically necessary, prescribed by a doctor, and actually rendered,” the DOJ statement said. “In truth and fact, none or virtually none of the purported services had been provided.”

The insurers paid almost $8 million of the $34.4 million that they were billed for.

Ruiz was an office administrator for Jesus Porras, who operated Ramirez Rehab Center, Long Life Medical Services, AA Ortiz Medical Center and Perez Medical Center. Porras is now on the lam, authorities said. Two more defendants, Anisley Gomez Anuez and Lidia Rodriguez Oviedo, also worked as office administrators and have been convicted or entered pleas. Their sentencings are set for September.

Ruiz’ sentencing is scheduled for October. She could face more than 30 years in prison, the DOJ said. She is listed as the manager of several other businesses in Florida, according to Florida Secretary of State records.