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Home/Legal & Regulatory and Reimbursement/Two Fake Ortho Companies Involved in $48M Health Care Fraud Scheme
Legal & Regulatory and Reimbursement

Two Fake Ortho Companies Involved in $48M Health Care Fraud Scheme

May 10, 2022 2 min read Premium comments

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Loyda Triana, a Florida woman, has pled guilty to her role in a Miami health care fraud scheme involving five fraudulent medical supply companies. Triana pled guilty to her role in the scheme that involved at least 15 other individuals. According to the plea agreement, from July 2017 through November 2019 Triana laundered $735,695.

Triana played only a small part in this scheme. According to the Department of Justice Press release, the fake companies, including two that posed as orthopedic companies, “billed Medicare, Medicaid, and private health insurers more than $48 million for medical equipment the companies never actually purchased and never actually provided to any patients.”

The fake medical supply companies involved in the scheme included the following: BF Distributors Corp, Timely Medical Services Corp., Ortho-Med Solution Inc., Expedited Medical Supplies Corp., and Prime Orthopedic Solutions Corp.

Triana was never actually an employee of any of the companies. Instead, she would cash checks issued by the companies and, per the Department of Justice press release, return the cash “minus a fee, to her co-conspirators.” According to the plea agreement, Triana returned most of the proceeds to her co-conspirators for their own use and to continue the fraud.

Per the plea agreement, Triana knew that the money she was receiving were proceeds from unlawful activity. Additionally, “Triana knew that the purpose of her receiving and cashing the checks was to conceal and disguise the nature, location, source, ownership, and/or control of the fraud proceeds.”

The checks she would cash contained false memos, such as “Paid commission 2%.” This was to make it appear as if Triana worked for the fraudulent companies.

Triana pled guilty to conspiracy to commit money laundering. Her sentencing date is May 25, 2022. According to court documents, she could face a “maximum term of imprisonment of twenty years, followed by a term of supervised release of up to three years.” She could also face a “fine of up to $500,000 or twice the value of the property involved in the transaction, whichever is greater.”

The FBI; Department of Health and Human Services, Office of the Inspector General; Federal Deposit Insurance Corporation, Office of the Inspector General; and Florida’s Medicaid Fraud Control Unit are investigating the case. The Justice Department’s Criminal Division’s Fraud Section is prosecuting the case.

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Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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