Case 1:16-cr-20010-FAM Document 98 Entered on FLSD Docket 05/11/2016 Page 1 of 6
UNITED STA TES DISTRICT CO U RT
SOU THER N DISTR ICT O F FL O RID A
C ASE N O .16-20010-CR-M O R EN O
UNITED STATES O F A M ER IC A
VS.
FERNA ND O M END EZ V ILLAM IL,
a/k/a uFernando M endez,''
Defendant.
/
The United States hereby files this factual basis in support of the change of plea of
defendant FERNA ND O M END EZ V ILLA M IL. In supportthereof,the governm entasserts the
follow ing facts:
Beginning on or about 2002, and continuing through on or about January 2016, the
defendant, FERN AN DO M EN DEZ VILLAM IL, along w ith defendants M aritza Exposito,
A rnaldo O Jim enez, and Yom ara Vila and others know n and unknow n to the governm ent
conspired to commitfraudulentschemes including (1)falsely billing M edkare and M edicaid
forpatientencounters thatdid not occur and were notmedically necessary;(2)providing false
diagnosis of psychiatric im pairments that were used to fraudulently obtain Social Security
disabilitybenefits;(3)falselycertifyingdiagnosisofpsychiatricimpairmentsonUSCIS Form N648 so thatpersons applying fornaturalization were fraudulently exem pted from the exam ination
required to satisfy the testing requirementin civicsand Ianguage;and (4)prescribing M edicaid
and M edicare beneficiariesm edicinesthatw ere notmedically necessary.
Case 1:16-cr-20010-FAM Document 98 Entered on FLSD Docket 05/11/2016 Page 2 of 6
DefendantM endez V illam ilwasa Florida Iicensed physician w ith a psychiatric practice in
M iam i, Florida.
During 2002 through 2010, defendant M endez V illam il w as a M edicaid
provider authorized to subm it claim s to Florida M edicaid and during 2002 through 20l3,
defendant M endez Villam ilwas a M edicare provider authorized to subm it claim s to M edicare.
W hile the governm entdoesnotbelieve thatevery patientseen by the defendantand every patient
record produced by the defendantinvolved a fraudulentclaim ,the governm entw ould have proven
that the defendant com m itted the various types of fraud m entioned above in the m anner
sum m arized below .
Beginning 2002 and continuing through January 20 l6,individuals who wert seeking to
obtain SocialSecuritydisability benefitspaid approximately $1,500 incashpaymentsinexchangefora
false m ental diagnosis from defendant M endez V illam il in support of their disability
application. Defendant M endez V illam il. in som e instances, back dated patients' records to
intentionally mislead the SocialSecurity Administration (SSA)into believingtheindividualhada
Iong term m entalhealth treatm enthistory thatdid not in fact exist. Defendant M endez Villam il
provided sam ple patient progress notes to defendant Exposito and other co-conspirators and
instructed them how to clone and falsify patient records.These false and fraudulent m edical
records were then faxed to the SSA to supportthe disability application ofthose individuals that
paid cash to defendantM endez V illam il. The SSA.relying on the authenticity ofthe diagnosis
and clinicalrecordssubm itted by defendantM endez Villam il,paid disability benefits in excess of
$20,302,923 to individualsand theirdependentsthatwerenotqualified oreligible to receivesuch
benefits.
Exam plesofthis fraudulentschem e w ere audio and video recorded on April22,2015 and
April30,20l5.by aConfidentialSource (CS)who wasgainfully employed atthe timeand not
2
Case 1:16-cr-20010-FAM Document 98 Entered on FLSD Docket 05/11/2016 Page 3 of 6
sufferfrom any mentalillness. He paid the required $1,500 in cash and obtained a disabling
m entaldiagnosis from defendantM endez Villam il. During the April30,20l5 m eeting betw een
the CS and defendant M endez Villam il,defendant M endez Villam iltold the C S that,'çw e w ill
begininJanuaryoflastyear,2014'9(meaningthemedicalrecordswouldbebackdatedoneyear).
Afterdiscussing with theCS how heshouldworkiioffthebooks''tojustify hisdisabilityclaim,
defendant M EN D EZ-V ILLA M IL then talked to the CS about the process to obtain disability
benefits(e.g.,how Iong ittakes,denial,and appeal). DefendantM ENDEZ-VILLAM IL told the
CS he would put down a severe diagnosis, because the C S
M EN DEZ-VILLAM IL then described
young.
bi-polar disorder to the CS.
Defendant
D efendant
M EN D EZ-V ILLA M IL then told the CS thathe wasgiving him a prescription form edication that
he could pick up cheaply,butcautioned the CS notto take it. DefendantM EN DEZ-V ILLA M IL
stated the CS did nothave to see him every m onth but that he,M END EZ-VILLA M IL,would
documentthe f5le m onthly as ifhe had done so. DefendantM EN DEZ-VILLAM IL said thatifthe
CS did not have time to see him ,the CS should com e in forhis appointm entand ask SsM aritza''
(meaningEXPOSITO)fortheprescription andM ENDEZ-VILLAM IL would send itoutto him
(inthe reception room). DefendantM ENDEZ-VILLAM IL emphasizedthatitwasimportantthat
the CS tillthe prescriptions.
In O ctober2015,the SSA faxed a requestforinformation regarding the CS'sdiagnosisand
treatment to defendant M EN D EZ-V ILLA M IL'S om ce,as is routinely done when a disability
applicantcites a treating physician. O n N ovem ber I8,2015,defendantM EN DEZ-V ILLAM IL'S
office forw arded,via w ire,to the SSA 35 pages ofm edicalrecords and completed a United States
Citizenship and Imm igration Services (USCIS) form that included an Initial Psychiatric
Evaluation dated January 23,2014,and m onthly ProgressN otes forthetim e period February 2014
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through N ovem ber 13,2015. The Evaluation and ProgressN otes have what appearsto be the
signature of defendant M END EZ-VILLAM IL. The CS was shown w hat purports to be his
signature in the initial psychiatric evaluation and he stated it is not his signature. Defendant
M EN DEZ-V ILLA M IL purports,on the form signed on N ovember l4,2015,thatthe CS suffers
from ûlauditory hallucinations,'' is iidisheveled,'' and diagnosed as itbipolar,'' dldepressed with
Psychosis''w ith a iipoor''prognosis.
In addition to the fraudulent schem e docum ented in the recording m entioned above,
several witnesses will testify that beginning as early as 2002 and continuing through 20l6,
defendant M endez Villam il w ould create fraudulent m edication m anagem ent records
docum enting patientvisitsthatneveroccurred. In som e instances individuals would com e in to
hisoffice,sign in for approxim ately 5 or6 individuals thatwere notactually present,m eetw ith
M endez V illam iland obtain prescriptions forthose individuals w ho w ere notpresent. In other
instances,individuals w ould sim ply w alk up to the reception desk and pick up a prescription for
psychotropic m edications.
Defendants M endez V illam il, Exposito, Vila, and other
co-conspirators would then create progress notes docum enting patientvisits thatnevertook place
on the dates prescriptions were dispensed. Defendant M endez Villam ilwould then use those
false m edicalrecordsto supporthis billing to M edicare and M edicaid. lnterview sof individuals
that w ere receiving these prescriptions and filling them revealed that they never needed the
medicationsand were notusing them,asinstructed. Asa result,approximately $25,905,372 in
false claim s w ere subm itted to the Florida M edicaid program of which approximately
$16,711,447 werepaid forofflce visitsthatneveroccurred and formedicationsthatwere neither
needed nor taken.
In addition, approximately $15,787,675 in false claim s was
subm itted to the M edicare PartB and D program ofwhich approximately $12,868,071waspaid
4
Case 1:16-cr-20010-FAM Document 98 Entered on FLSD Docket 05/11/2016 Page 5 of 6
foroffice visitsthatneveroccurred and m edicationsthatwere neitherneeded nortaken.
Beginning 201l and continuing through January 2016, in exchange for cash paym ents,
M EN DEZ-VILLAM IL and his co-conspirators provided fraudulently certified USCIS Forms
N -648,M edicalCertification forD isability Exceptions,to residentalienswho w ere applying for
naturalization. USCIS form N -648 is intended for an applicantw ho seeks an exception to the
English and/orcivics requirem entsfornaturalization due to a physicalordevelopm entaldisability
ormentalim pairm entthathas Iasted,orisexpected to last,12 m onthsorm ore. Patientrecruiters
would com e in to defendant M endez Villam il's office, m eet w ith him and provide him the
biographicalinform ation ofresidentaliensw ho were seeking to obtain disability certificationsfor
USCIS. Defendant M endez Villam il w ould instruct his co-conspirators to create patient
records supporting a false m ental disability diagnosis and Forms N -648. These false Form s
N -648 were then created by defendant Exposito and otherco-conspiratorsand given to patient
recruitersand individualsw ho then subm itted them to USCIS,in orderto obtain a waiverfrom the
English and/orcivic requirementsofthe U .S.naturalization process,aswellasany fessthatw ere
associated w ith that process. A s a result of these false and fraudulent form N -648s, U SCIS
waived imm igration feesin excessof$814,640 to scoresofindividualswho wereotherwise not
entitled to receive such w aivers.
Furtherm ore,in or around 2004,at the request of defendant M EN D EZ-V ILLAM IL and
Individual3,defendantsJIM EN EZ and EXPOSITO introduced Individual2 (asmentioned inthe
Indictment)to defendantM ENDEZ-VILLAM IL asa person interested in marrying lndividual3
forthe purposeofevading a provision ofthe im m igration law softhe United States. ln return for
participating in the false marriage with Individual3,defendantM EN D EZ-V ILLAM IL offered to
assist Individual2 to fraudulently obtain SSA disability benefits and cash paym ent. Defendant
5
Case
1:16-cr-20010-FAM Document 98 Entered on FLSD Docket 05/11/2016 Page 6 of 6
#
EXPO SITO assisted defendant M EN DEZ-V ILLA M IL in the preparation of fraudulent Progress
Notesforlndividual2 and provided unnecessary prescriptionsforXanax to lndividual2.
These events occurred in M iam iDade County, in the Southern D istrict of Florida and
elsew here.The above-described factssel've only as a sum m ary ofthe testim ony w ere this case to
proceed to trialand are notintended to be an exhaustive accountofalIthe inform ation available to
the Governm entconcerning the offensescharged in the Indictm ent.Ifthis case were to go to trial
the G overnm entwould be in aposition to prove alIofthe above bç
nd a reasonable doubt.
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Hager nes K.Sim mons
Specia ssistantU.S.Attorney
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Phillip L.Reizenstein
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By:
Jorge L. '
Attorney for Defendant
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Defendant