Orthopaedic surgeon faces fraud charges over Medicaid after losing professional licence
Jorge Rodríguez Wilson was suspended by the Medical Licensing and Discipline Board in February, yet continued billing and treating patients despite lacking authorisation.
Orthopaedic surgeon faces fraud charges over Medicaid after losing professional licence
A specialist in bones and joints based in Puerto Rico was charged on Wednesday in connection with a fraud scheme against the government health system, despite having lost his authorisation to practise months earlier.
According to Roberto Pérez Nieves, head of the Medical Licensing and Discipline Board, the licence of Jorge Rodríguez Wilson was cancelled immediately on 28 February through a unanimous determination by the agency. Notification reached him on 4 March. The reasons: serious errors in procedures, failure to report legal judgements against him, and inaccurate information in renewal applications.
The ruling required alerting without delay clinics, hospitals and other institutions so they would not permit him to continue his work. Rodríguez Wilson was warned that he must cease all medical practice and was subject to monetary penalties along with permanent annulment of his licence.
However, between March of last year and January of this year, the professional—through his business Wilson Orthopaedics and Rehabilitation Center and also individually—submitted fraudulent billing to Medicaid, Medicare and private insurers. During that same period he continued evaluating, diagnosing and treating patients, despite lacking the proper authorisation.
Javier Ortiz Hernández, administrator of the practice, was also named for performing medical functions without a professional licence, in addition to preparing billing documents.
The prosecution, represented by Brenda Rosado Aponte, filed 81 charges against Rodríguez Wilson. These include unlicensed practice, submitting fraudulent claims to the state health plan, prescribing controlled drugs without proper authorisation, fraud and misappropriation of public resources. The business entity faces 64 charges for misappropriation and fraud, whilst Ortiz Hernández faces 28 counts of fraud, falsification of documents and unlicensed practice.
The investigation determined that the physician billed slightly more than one million five hundred ninety thousand dollars, of which approximately nine hundred thirty-five thousand was paid into his personal account.
Judge Lisa M. Durán Ortiz, of the First Instance Court of the capital, found there were sufficient grounds to order the detention of the three involved parties and set total bail at $109,000. The preliminary hearing was scheduled for late June.
_Source: Metro Puerto Rico_
Source: Google News PR — Crime