José Dávila Núñez, a 51-year-old businessman from Miami, received a federal prison sentence of 63 months on October 11, followed by three years of supervised release, for his role in a Medicaid fraud scheme. Additionally, he was ordered to pay $3,869,703 in restitution. Dávila had pleaded guilty on June 14 to conspiracy to commit healthcare fraud.
According to court documents and the agreed statement of facts, Dávila and his accomplices established a mental health clinic named New Behavior Health Direction, Incorporated (New Behavior), in Hialeah Gardens, Florida, using a fake owner as a front. Between April 2019 and September 2020, they submitted false claims to Medicaid totaling $3,869,703 for providing psychosocial rehabilitation (PSR) services, a type of therapy intended to assist individuals with disorders such as depression and anxiety. In September 2020, the fictitious owner cashed out the fraudulent proceeds, shared some with Dávila, and then escaped to Cuba. Dávila's company, Max Medical Consulting Services, Incorporated, based in Miami, received about $500,000 from the fraudulent proceeds generated by New Behavior.
Additional Fraud and Its Consequences
During the sentencing hearing, Dávila was also held accountable for an additional $2,617,992 in fraud related to bribes he and his partners paid to patients between November 2018 and December 2022. These bribes were in exchange for receiving PSR services at three other Miami clinics: Davila Medical Center, Incorporated, Advanced Community Wellness Center, and Larkin Behavior Health, Incorporated. The U.S. government managed to seize approximately $1.7 million in cash linked to New Behavior’s bank accounts.
Widespread Fraud in South Florida
This case adds to the expanding list of fraudulent activities in South Florida, many involving Cuban nationals or individuals with ties to the island. The region has been a hotspot for various healthcare fraud schemes, particularly targeting Medicaid and Medicare, prompting authorities to ramp up efforts to combat these criminal activities.
On April 1, 2024, Ariel Núñez Finalet, a Cuban national, was sentenced in Miami for defrauding Medicare of nearly $17 million. Núñez had been a fugitive for a decade, part of a network that filed fraudulent claims for unnecessary medications through Florida pharmacies. Subsequently, on April 3, 2024, Lisandra Santana, a young woman from Hialeah, was charged with staging an accident to claim insurance and therapies, feigning injuries to obtain money. Police discovered she had intentionally deployed her vehicle’s airbag to make the fraud believable.
Recent Fraudulent Activities
In early May, two Cuban women, María Campos and Isabela Méndez, were arrested for setting up a fake car accident in Miami to file fraudulent medical claims exceeding $35,000. A day later, on May 2, 2024, Krystal Arbona, another young Cuban, was accused of orchestrating a $40,000 insurance fraud following a traffic accident in Miami. Investigations revealed the claimed therapies were never administered.
On July 2, 2024, authorities arrested Margelys Moreira Pino, a Cuban in Miami-Dade, for bribing patients to claim nonexistent medical services to Medicare, resulting in over $100,000 in fraudulent claims. Finally, on July 23, 2024, another Cuban in Miami, Agustín García Marsán, was apprehended for scamming elderly individuals in a grandparent scam, swindling them out of thousands of dollars.