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Thursday, August 4, 2016

Four Individuals Arrested For Social Security Fraud

Press Release

U.S. Attorney's Office - San Juan

SAN JUAN, P.R. - On August 2nd, 2016 a Federal Grand Jury in the District of
Puerto Rico returned a 16-count indictment charging one doctor, Americo Oms-
Rivera, his secretary Mayte González Muñoz, and Francisco Cabrera Alvarado,
a former Social Security Administration (SSA) employee, for fraud in the appli-
cation process for SSA disability insurance benefits in Puerto Rico, announced
United States Attorney for the District of Puerto Rico, Rosa Emilia Rodríguez

Defendants are also facing charges for wire fraud, false statement or representa-
tion to SSA, dispensing controlled substances by a practitioner (diversion), hea-
lth care fraud, and aggravated identity theft.

The SSA is responsible for the implementation of the Disability Insurance Bene-
fits Program. The SSA provides monetary benefits to workers with severe, long-
term disabilities, who have worked in SSA covered employment for a required
length of time. Spouses and dependent children of disabled workers may also be
eligible to receive benefits.

Pursuant to SSA regulations, a claimant must prove to SSA that he or she is dis-
abled by furnishing medical and other evidence with the application. The applica-
tion and supporting evidence is then evaluated by SSA to determine the individu-
al’s medical impairments and determine the effect of the impairment on the clai-
mant’s ability to work on a sustained basis.

The indictment alleges that on or about September 24, 2013, Person A was intro-
duced to Oms-Rivera to discuss his intentions of applying for disability insurance
benefits. During said meeting, Oms-Rivera informed Person A that he/she needed
to seek treatment for a period of five (5) to six (6) months before the paperwork
was submitted to the SSA. Oms-Rivera told Person A that once Person A’s disabi-
lity benefits were approved he would take a percentage of the check as payment.
The scheme involved, among others, the following acts alleged in the indictment:

* On or about January 14, 2014, Person A had the first medical appointment with
Oms-Rivera. During this visit, Person A informed the doctor that he/she was inter-
ested in obtaining SSA disability insurance benefits. Person A reported that his/her
medical conditions were high blood pressure and migraines from time to time. In
response, Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for depre-
ssion and panic disorders and Restoril, a Scheduled IV narcotic used to treat insom-
nia symptoms.

* Person A made additional visits to Oms-Rivera for purported medical treatment.
During these visits Oms-Rivera and Person A discussed the disability application
process and Oms-Rivera prescribed Prozac, a non-controlled narcotic, used for de-
pression and panic disorders; Restoril, a Scheduled IV narcotic, used to treat ins-
omnia symptoms; Ambien, a Scheduled IV narcotic, used to treat insomnia; and
Xanax, a Scheduled IV narcotic, used to treat anxiety and panic disorders.

* Oms-Rivera and defendant González-Muñoz referred Person A to Cabrera, a
former SSA employee who worked as a non-attorney representative. Cabrera as-
sisted Person A in his application for SSA disability insurance benefits.

* On May 21, 2014, Cabrera met with Person A in order to assist him/her to fill
out the Adult Function Report, SSA Form 3373. During said meeting Cabrera
coached Person A as to what to write in the form in order to get Person A’s dis-
ability benefits approved.

* On June 10, 2014, González charged Person A $600.00 for the Psychiatric
Medical Report and $1,440.00 for backdating his/her medical file and creating
24 fictitious medical appointments.

* On or about October 22, 2015, the Psychiatric Medical Report signed by Oms-
Rivera was submitted to the SSA indicating that Person A was totally disabled to
return to work as of that date or in the near future. In the Psychiatric Medical Re-
port Oms-Rivera falsely represented to the SSA that Person A’s first medical visit
was on October 15, 2013. Oms-Rivera further reported a total of approximately
eleven (11) fictitious appointments that never took place. This was done to create
the appearance of a longer history of medical treatment.

The government is seeking the forfeiture of the medical license of Oms-Rivera since
he used it to facilitate the commission of controlled substances offenses when he pre-
scribed or dispensed controlled substances outside the scope of his medical practice.
The defendants are facing a maximum penalty of 5 years in prison for the conspiracy
to defraud the United States; up to 20 years in prison for wire fraud; up to 5 years in
prison for providing false statements to the SSA; up to 20 years for dispensing cont-
rolled substances by a practitioner (diversion); 10 years for health care fraud; and a
statutory term of two years in prison, consecutive to any other sentence, for the agg-
ravated identity theft charges.

Beneficiary Julio Rodríguez Ríos was charged in a separate indictment with theft
of government property and false statement or representation to SSA. That second
indictment alleges that Rodríguez-Ríos provided false statements to the SSA, during
a “Continuing Disability Review,” indicating that he had not worked since July 5,
2009, when in fact he had worked after said date. Rodríguez Ríos is facing a forfei-
ture allegation of $25,316.00 in United States currency.

“This is another Social Security Disability Benefits Fraud case where shameless in-
dividuals illegally facilitated and obtained the benefits provided by the Federal Go-
vernment. This is not a victimless crime, but rather an unacceptable act that depri-
ves those who truly need assistance from receiving it,” said United States Attorney
Rosa Emilia Rodríguez-Vélez. “The Department of Justice is committed to investi-
gate and prosecute those who engage in fraudulent schemes.”SSA-OIG Special Ag-
ent-in-Charge John Grasso said: “The Social Security Disability Insurance program
is intended to support individuals truly in need of this important and earned  benefit.
The program relies on the truthfulness of disability applicants, as well as other pro-
fessionals involved in the application process, to include physicians, attorneys, and
non-attorney representatives. It is particularly disturbing when people in positions
of trust engage in criminal activity that undermines Social Security’s programs and
their own professional responsibility. I am very grateful for the efforts of all of our
law enforcement partners involved in this investigation, and for the continued com-
mitment from the United States Attorney’s Office for the Commonwealth of Puerto
Rico to aggressively pursue these important cases. I strongly encourage the public
to report suspected instances of Social Security fraud to the OIG’s Fraud Hotline
at 1-800-269-0271 or https://oig.ssa.gov/report.”

The case was investigated by the Social Security-OIG with the collaboration of the
FBI, DEA, Health and Human Services, and the Puerto Rico Police Department.
The case was indicted by Special Assistant United States Attorney Vanessa D. Bo-

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