At least five people have been arrested in Miami-Dade for insurance fraud related to pediatric dental procedures, authorities confirmed Tuesday.
The actions of individuals identified as Mercedes Maria Linares, 53, Christi Carol Olson, 47, Ryon William Vazquez, 33, Leonel Ravelo, 34, and Leonardo Ramos, 23, resulted in a spoofing scheme. identity, to false and fraudulent insurance claims to defraud in the sum of $1.3 million.
According to the authorities’ report, faced with accreditation and licensing problems within the clinic, the stakeholders tried to convince the associated doctors to change and accept a new billing process. Thus, the services rendered by the dental assistants would be signed by the accredited doctors even if they do not administer or supervise the treatments.
Some physicians disagreed with this because they did not oversee the processes, they would not be paid, and they did not want to use their licenses without their direct intervention.
It is known that around May 2022, Dr. Ravelo ordered the director of the Little Havana office to use the Behavior Management Code (BMC) on all children under the age of six without their knowledge or consent from doctors to increase production and achieve financial goals, all in exchange for a monetary bonus.
Code of conduct management allows for additional compensation for a dentist who treats people with disabilities or developmental issues due to the increased time, personnel, demands and expertise involved in the dental procedure.
At least six doctors at the clinic discovered this fraudulent scheme that bundled together claims for services not rendered and attempted to stop billing at the Little Havana practice while auditing all BMC-type claims.
Doctors’ audit and physical evidence obtained revealed 50 fraudulent claims, of which 47 were ready to be filed, four of these false insurance claims were filed, billed and paid.
The alleged incidents also allegedly took place at AC Pediatric Dentistry & Orthodontics, a medical office located at 4410 W and 16th Ave in Hialeah.