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Numerous complaints were received from private insurance carriers by the San Diego Division of the FBI, as well as other FBI offices, regarding fraudulent billing practices by foreign providers. Dr. Joseph Merlos, a foreign provider, and LeRoy Alexander, a US billing service owner, were identified among the group of foreign providers and US billers involved in this type of fraudulent activity.
Illustrating the magnitude of the fraudulent billings, one insurance company suffered losses in excess of $300,000 a month to this group. Merlos and Alexander were also suspected of simultaneously billing at least 48 other insurance companies. The losses were estimated to be in the millions.
OBJECTIVES OF OPERATION “SURE BUCK”
The FBI in San Diego initiated a unique, covert operation in an effort to take a more proactive approach to health care fraud. The goals of this investigation were to identify and ascertain those foreign and US providers who maintained a nexus within the United States and the US based billing services and suppliers which routinely assist those providers in the following areas:
- Submitting claims for services not rendered.
- Inflating fees to maximize insurance reimbursement.
- Concealing the location of the hospitals/clinics the billing services represent, and,
- Misrepresenting services rendered through widespread billing manipulation to defraud US private insurance companies.
DEFENDANTS NAME | CITIZEN OF | RESIDES IN |
LeRoy Alexander | US | Bonita, CA |
Dr. Joaquin Merlos | Mexico | Mexico |
Dr. Adrian Vasquez | Mexico | Mexico |
Dr. Antonio Rodriguez | Mexico | Mexico |
Dr. Fernando Eng | Mexico | Mexico |
Dr. Pascual Figueroa | Mexico | Mexico |
Dr. Elizabeth Quintana | Mexico | Mexico |
Dr. Jose Angel Mungula | Mexico | Mexico |
Dr. Marco Antonio Cordova | Mexico | Mexico |
Dr. Antonio Oceguera | Mexico | Mexico |
Dr. Javier Meda Anaya | Mexico | Mexico |
Dr. Pablo Flores Duenas | Mexico | Mexico |
Dr. Victor Cubillas | Mexico | Mexico |
Dr. Luis Valdez | Mexico | Mexico |
Dr. Martin Maclas | Mexico | Mexico |
Dr. Jose Miro | Mexico | Mexico |
Dr. Silvia Flores | Mexico | Mexico |
Dr. David Ledezma | (Dual) US/Mexico | Mexico |
Javier Ramirez Merlos | Mexico | Mexico |
David Paler | US | La Mesa, CA |
Salvador Vega |
US | Chula Vista, CA |
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