A Florida man has pleaded guilty to two counts of conspiracy to commit health care fraud and one count of making a false statement in a matter involving a health care benefit program.
Patsy Truglia, 53, Parkland, faces a maximum penalty of 15 years in federal prison. A sentencing date has not yet been set.
According to the plea agreement and other court documents, beginning in January 2018 and continuing into April 2019, Truglia and other conspirators, including co-defendant Ruth Bianca Fernandez (who worked under Truglia’s supervision), generated medically unnecessary physicians’ orders via their telemarketing operation for certain orthotic devices—i.e., knee braces, back braces, wrist braces, and other braces—referred to as durable medical equipment (“DME”). Through the telemarketing operation, federal health care program beneficiaries’ (i.e., Medicare beneficiaries’) personal and medical information was harvested to create the unnecessary DME brace orders.
The brace orders were then forwarded to purported “telemedicine” vendors that, in exchange for a fee, paid illegal bribes to physicians to sign the orders, often without ever contacting the beneficiaries to conduct the required telehealth consultations.
The fraudulent, illegal brace orders were then returned to Truglia’s telemarketing operation, which used the orders as support for millions of dollars in false and fraudulent claims that were submitted to the Medicare program.
To avoid Medicare scrutiny, Truglia and Fernandez spread the fraudulent claims across five DME storefronts operated under Truglia’s ownership and control, and Fernandez’s day-to-day management. In all, through their five storefronts, Truglia, Fernandez, and other conspirators caused approximately $25 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $12 million in payments.
On April 9, 2019, multiple federal law enforcement agencies participated in a nationwide action referred to as “Operation Brace Yourself.” The Operation targeted ongoing schemes, such as Truglia’s, in which companies were paying illegal bribes to secure signed physicians’ DME brace orders for use as support for fraudulent claims that were submitted to the federal programs. In the Middle District of Florida, the Operation included, among other efforts, the execution of search warrants at several of Truglia’s DME storefronts and a civil action which, among other ramifications, enjoined Truglia and (by extension) his five storefronts from engaging in any further health care fraud conduct.
Undeterred by this action, beginning in or around April 2019, and continuing into July 2020, Truglia and other conspirators—some who had worked with Truglia in the earlier conspiracy, as well as some new conspirators—carried out a similar conspiracy using three new DME storefronts and different “telemedicine” vendors.
Through this conspiracy, Truglia and his conspirators caused an additional approximately $12 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $6.3 million in payments.
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