San Juan County Man Pleads Guilty to Federal Health Care Fraud Charge
ALBUQUERQUE – Cory Werito, 33, of Farmington, N.M., pled guilty today in federal court in Albuquerque, N.M., of defrauding the federal government. The guilty plea was announced by U.S. Attorney Damon P. Martinez and Special Agent in Charge Waldemar Rodriguez of Homeland Security Investigations (HSI) in El Paso.
John Benson, CEO of Verisys Corporation says, “Scamming the health care system is endemic and drives up the cost of health care. Eliminating fraud would be a giant step towards achieving Congress’ goal of affordability. It would require massive changes to existing flawed systems and challenging the CMS contractors whose very expensive systems just add more cost by engaging in the pay and chase game. We need to have an honest discussion about prevention and it starts with a solid gatekeeping and monitoring strategy, something that Verisys delivers in the commercial sector today.”
Werito and his co-defendant, Rosita Toledo, 47, of Kirtland, N.M., were charged in a ten-count indictment that was filed on June 15, 2016. The indictment included nine health care fraud charges against Werito and Toledo, and an aggravated currency structuring charge against Werito. According to the indictment, the health care fraud charges were based on the defendants’ roles in creating and operating a medical transportation company, CW Transport, a New Mexico company located in Farmington that provided non-emergency medical transportation to Arizona Medicaid recipients, funded by reimbursement payments from the Arizona Health Care Cost Containment System (AHCCCS), a healthcare benefit program. The indictment alleged that over the course of two years between 2011 and 2013, CW Transport collected more than $1.9 million in Medicaid reimbursements from AHCCCS by submitting more than 18,000 claims for reimbursement, the vast majority of which were wholly or substantially false and fraudulent.
Count 10 of the indictment, the aggravated currency structuring charge, alleged that Werito conducted financial transactions involving the proceeds of the health care fraud in a manner that avoided the filing of Currency Transaction Reports (CTRs). CTRs are reports which must be filed by financial institutions on transactions involving more than $10,000 during any business day and are used by law enforcement authorities to uncover a broad range of illegal activities including money laundering. According to the indictment, from Aug. 2011 to July 2013, Werito conducted at least 200 cash withdrawals, each for several thousands of dollars but less than $10,000 and totaling at least $800,000, to avoid the filing of CTRs.
The indictment included forfeiture provisions seeking an order requiring Werito and Toledo to forfeit to the United States at least $1,959,405, the proceeds allegedly derived from the health care fraud alleged in Counts 1 through 9 of the indictment.
During today’s proceedings, Werito pled guilty to Count 1 of the indictment, charging him with committing health care fraud. Werito admitted, as the sole owner of CW Transport, he submitted approximately 18,765 claims for reimbursement to AHCCCS between July 2011 and July 2013. Because the claims were grouped in 140 invoices, Werito received 140 payments from AHCCCS in an amount totaling $1,959,405. Werito admitted submitting the claims for reimbursement as part of a scheme to defraud AHCCCS because he either never provided or provided in a substantially different manner many of the services for which he sought and received reimbursement.
At sentencing, Werito faces a maximum penalty of ten years in federal prison. Under the terms of his plea agreement, Werito also will be required to pay $1,218,165 in restitution. A sentencing hearing has yet to be scheduled.
Toledo has entered a plea of not guilty to the charges in the indictment and is pending trial which has yet to be scheduled. Charges in indictments are merely accusations and defendants are presumed innocent unless found guilty in a court of law.
The Albuquerque office of HSI investigated the case with assistance from the FBI, U.S. Marshals Service, San Juan County Sheriff’s Office, the Arizona Health Care Cost Containment System and New Mexico Office of the Attorney General (OIG). Assistant U.S. Attorney Jeremy Peña is prosecuting the case.
|Written by Susen Sawatzki
Healthcare Industry Expert
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