The Biggest Healthcare Fraud Case? 10 Defendants Charged $1.4 Billion For Grand Hospital Scheme


Photo Credit: Brittany Reuss/ Tribune


On June 29th, 2020, one of the largest healthcare fraud cases was unsealed and reported to the public. Ten defendants, of whom included hospital managers, laboratory owners, billers, and recruiters were charged a whopping $1.4 Billion for an “elaborate pass-through billing scheme using rural hospitals in several states as billing shells to submit fraudulent claims for laboratory testing” revealed the Department of Justice. According to the indictment, filed in U.S. District Court in Jacksonville, Florida, from around November of 2015 to February of 2018, “the conspirators billed private insurance companies approximately $1.4 billion for laboratory testing claims as part of this fraudulent scheme and were paid approximately $400 million”.


Hospitals involved:

  • Cambellton-Graceville Hospital (CGH), Regional General Hospital of Williston, Chestatee Regional Hospital, and Putnam County Memorial Hospital.


Those listed on the inditement:

  • Jorge Perez (60), Seth Guterman (54), Ricardo Perez (57), Aaron Durall (48), Neisha Zaffuto (44), Christian Fletcher (34), James Porter Jr. (49), Aaron Alonzo (44), Nestor Rojas (45), and Sean Porter (52).


Charges:

  • One count of conspiracy to commit health care fraud and wire fraud: Jorge Perez, Seth Guterman, Ricardo Perez, Aaron Durall, Neisha Zaffuto, Christian Fletcher, James Porter Jr., and Aaron Alonzo, Nestor Rojas.

  • Five counts of substantive health care fraud: Jorge Perez, Guterman, Ricardo Perez, and Aaron Durall

  • Two counts of conspiracy to commit money laundering: Aaron Durall and Neisha Zaffuto

  • One count of conspiracy to commit money laundering: James Porter and Sean Porter

  • Substantive money laundering: Aa