A medical assistant at a pair of large medical services companies with offices in New Jersey and New York admitted last week to conspiring with the companies’ chief executive officer to defraud Medicare over a four-year period by performing illegal, unlicensed physicians’ services for patients, U.S. Attorney Paul J. Fishman announced.
Mario Roncal, 61, of Woodland Park, New Jersey, pleaded guilty before U.S. District Judge Jose L. Linares in Newark federal court to an indictment charging him with one count of conspiracy to commit health care fraud.
According to documents filed in this case and statements made in court:
In 1988, Roncal received a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico. Since that time, however, he was never licensed to practice medicine in New Jersey, New York, or any other state in the United States. In 2000 and 2002, Roncal was advised by the New Jersey Board of Medical Examiners that he were ineligible to obtain a medical license in New Jersey because his medical school was not accredited and he lacked certain requirements for international medical students to obtain a license in the United States.
From 2004 to the present, Roncal was employed ostensibly as a medical assistant for Cardio-Med Services LLC in New Jersey and for Comprehensive Healthcare & Medical Services LLC in Manhattan and Queens, New York. These companies were owned and operated by the CEO and head physician at Cardio-Med and Comprehensive Healthcare, who is a board-certified cardiologist licensed to practice medicine in New Jersey and New York, and who is identified in the indictment as the “CEO-physician.”
According to Roncal, from 2004 through at least 2008, he conspired with the CEO-physician to cause Cardio-Med and Comprehensive Healthcare to submit false billing claims to Medicare representing that physicians’ services had been provided by the CEO-physician when those services had, in fact, been provided by Roncal. Roncal admitted that he held himself out to fellow employees and to patients as “Dr. Roncal” and that he examined new patients as well as the CEO-physician’s follow-up patients. He also admitted that he ordered diagnostic tests for patients; diagnosed patients with medical conditions, diseases, and the like; and recommended and prescribed courses of treatment, including surgery and enhanced external counter pulsation (or EECP) for patients. Roncal stated that he intentionally ordered unnecessary diagnostic tests for the patients he unlawfully treated and that he willfully misdiagnosed patients with diseases and conditions such as coronary artery disease and angina, for the purpose of fraudulently prescribing and administering treatments of EECP, at the direction of the CEO-physician. To disguise that he, rather than the CEO-physician, was providing these physicians’ services to patients, Roncal forged the CEO-physician’s signature on paperwork associated with these unlawful services, including on prescription pads and patient charts.
The count to which Roncal pleaded guilty is punishable by a maximum potential penalty of 10 years in prison. Sentencing is scheduled for April 17, 2013.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Acting Special Agent in Charge David Velazquez; the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Thomas F. O’Donnell; the U.S. Postal Inspection Service, under the direction of Acting Inspector in Charge Marie Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Acting Special Agent in Charge Shantelle P. Kitchen; and criminal investigators at the U.S. Attorney’s Office, for the investigation leading to the guilty plea.
The case is being prosecuted by Assistant U.S. Attorney Scott B. McBride the U.S. Attorney’s Office’s Health Care and Government Fraud Unit.
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