Doctor Pleads Guilty To Social Security Fraud

From the U.S. Attorney’s Office, District of Puerto Rico:

SAN JUAN, P.R. – Defendant Americo Oms-Rivera plead guilty before United States District Judge Francisco A. Besosa to conspiracy to commit wire fraud, announced W. Stephen Muldrow, United States Attorney for the District of Puerto Rico.

On August of 2016, a Federal Grand Jury in the District of Puerto Rico returned a 16-count indictment charging doctor Americo Oms-Rivera, his secretary Mayte González Muñoz, and Francisco Cabrera Alvarado, a former Social Security Administration (SSA) employee, for fraud in the application process for SSA disability insurance benefits in Puerto Rico. González-Muñoz and Cabrera Alvarado plead guilty on March of 2017.

The SSA is responsible for the implementation of the Disability Insurance Benefits 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 disabled by furnishing medical and other evidence with the application. The application and supporting evidence is then evaluated by SSA to determine the individual’s medical impairments and determine the effect of the impairment on the claimant’s ability to work on a sustained basis.

The defendant admitted that starting on March 2009, until on or about October of 2015, the defendant and other co-conspirators knowingly and willfully conspired and agreed together and with each other, to devise a scheme and artifice to defraud the SSA, and to obtain money and property by means of materially false and fraudulent pretenses, representations and promises. For example, Oms Rivera would backdate medical records of patients applying for disability insurance benefits by creating fictitious medical appointments that never took place. This was done to create the appearance of a longer history of medical treatment and for the purpose of tricking or deceiving the SSA into approving disability insurance benefits.

As part of the plea agreement, Oms Rivera will pay SSA $321,000 in restitution, and agreed to the forfeiture of a property at Palmas del Mar, Humacao.  In addition, Oms Rivera will surrender his DEA license, and will be excluded from participating in SSA cases, as well as Medicare, Medicaid and all other federal health care programs.

“We will continue to aggressively investigate and prosecute anyone who seeks to defraud or exploit the federal assistance programs established to help the most vulnerable of our communities,” said U.S. Attorney Muldrow. “This defendant abused the trust placed in him as a professional for personal gain. We thank our law enforcement partners for their years-long investigation and commitment to this case.”

“Today’s guilty plea represents years of hard work by OIG investigators as well as the U.S. Attorney’s Office, to gather evidence of this fraud scheme,” said Gail S. Ennis, Inspector General of the Social Security Administration. “Dr. Oms submitted false medical evidence in support of Social Security disability claims, which is a betrayal of the public trust—one we take very seriously. We will continue to pursue those who facilitate Social Security fraud, and I encourage the citizens of Puerto Rico to report allegations to our hotline at oig.ssa.gov.”

This case was investigated by the Social Security Administration Office of the Inspector General, New York Field Division, under the supervision of Special Agent-in-Charge John F. Grasso.  Special Assistant United States Attorney Vanessa D. Bonano-Rodríguez from the Social Security Administration was in charge of the prosecution of the case.

SAN JUAN, P.R. – Defendant Americo Oms-Rivera plead guilty before United States District Judge Francisco A. Besosa to conspiracy to commit wire fraud, announced W. Stephen Muldrow, United States Attorney for the District of Puerto Rico.

On August of 2016, a Federal Grand Jury in the District of Puerto Rico returned a 16-count indictment charging doctor Americo Oms-Rivera, his secretary Mayte González Muñoz, and Francisco Cabrera Alvarado, a former Social Security Administration (SSA) employee, for fraud in the application process for SSA disability insurance benefits in Puerto Rico. González-Muñoz and Cabrera Alvarado plead guilty on March of 2017.

The SSA is responsible for the implementation of the Disability Insurance Benefits 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 disabled by furnishing medical and other evidence with the application. The application and supporting evidence is then evaluated by SSA to determine the individual’s medical impairments and determine the effect of the impairment on the claimant’s ability to work on a sustained basis.

The defendant admitted that starting on March 2009, until on or about October of 2015, the defendant and other co-conspirators knowingly and willfully conspired and agreed together and with each other, to devise a scheme and artifice to defraud the SSA, and to obtain money and property by means of materially false and fraudulent pretenses, representations and promises. For example, Oms Rivera would backdate medical records of patients applying for disability insurance benefits by creating fictitious medical appointments that never took place. This was done to create the appearance of a longer history of medical treatment and for the purpose of tricking or deceiving the SSA into approving disability insurance benefits.

As part of the plea agreement, Oms Rivera will pay SSA $321,000 in restitution, and agreed to the forfeiture of a property at Palmas del Mar, Humacao.  In addition, Oms Rivera will surrender his DEA license, and will be excluded from participating in SSA cases, as well as Medicare, Medicaid and all other federal health care programs.

“We will continue to aggressively investigate and prosecute anyone who seeks to defraud or exploit the federal assistance programs established to help the most vulnerable of our communities,” said U.S. Attorney Muldrow. “This defendant abused the trust placed in him as a professional for personal gain. We thank our law enforcement partners for their years-long investigation and commitment to this case.”

“Today’s guilty plea represents years of hard work by OIG investigators as well as the U.S. Attorney’s Office, to gather evidence of this fraud scheme,” said Gail S. Ennis, Inspector General of the Social Security Administration. “Dr. Oms submitted false medical evidence in support of Social Security disability claims, which is a betrayal of the public trust—one we take very seriously. We will continue to pursue those who facilitate Social Security fraud, and I encourage the citizens of Puerto Rico to report allegations to our hotline at oig.ssa.gov.”

This case was investigated by the Social Security Administration Office of the Inspector General, New York Field Division, under the supervision of Special Agent-in-Charge John F. Grasso.  Special Assistant United States Attorney Vanessa D. Bonano-Rodríguez from the Social Security Administration was in charge of the prosecution of the case.