2017-11-15 / Top News

Woman defrauds Medicaid of almost $2 million

ROSITA TOLEDO ROSITA TOLEDO ALBUQUERQUE — Rosita Toledo, 48, of Kirtland, N.M., was sentenced today in federal court in Albuquerque, N.M., for her healthcare fraud conviction. Toledo was sentenced to a 25-month term of imprisonment followed by three years of supervised release, during which she will be required to perform 40 hours of community service each year. Toledo also was ordered to pay, jointly with her co-defendant, $1,218,165.00 in restitution to the victim of their criminal conduct.

Toledo and co-defendant Cory Werito, 33, of Farmington, N.M., were charged in a 10-count indictment that was filed on June 15, 2016. The indictment included nine health care fraud charges against Toledo and Werito, and an aggravated currency structuring charge against Werito. The health care fraud charges arose out of the defendants’ roles in creating and operating a medical transportation company, CW Transport, a New Mexico company located in Farmington that provided non-emergency medical transportation to Arizona Medicaid recipients, funded by reimbursement payments from the Arizona Health Care Cost Containment System (AHCCCS), a healthcare benefit program. Over the course of two years between 2011 and 2013, CW Transport collected more than $1.9 million in Medicaid reimbursements from AHCCCS by submitting more than 18,000 claims for reimbursement, the vast majority of which were wholly or substantially false and fraudulent.

According to Count 10 of the indictment, the aggravated currency structuring charge, Werito conducted financial transactions involving the proceeds of the health care fraud in a manner that avoided the filing of Currency Transaction Reports (CTRs). CTRs are reports which must be filed by financial institutions on transactions involving more than $10,000 during any business day and are used by law enforcement authorities to uncover a broad range of illegal activities including money laundering. From Aug. 2011 to July 2013, Werito conducted at least 200 cash withdrawals, each for several thousands of dollars but less than $10,000 and totaling at least $800,000, to avoid the filing of CTRs.

The indictment included forfeiture provisions seeking an order requiring Toledo and Werito to forfeit to the United States at least $1,959,405, the proceeds allegedly derived from the health care fraud alleged in Counts 1 through 9 of the indictment.

On March 30, 2017, Toledo entered a guilty plea to Count 1 of the indictment, and admitted her role in the health care fraud scheme. In entering her guilty plea, Toledo admitted that between July 2011 and July 2013 and in her capacity as the primary claims processor for CW Transport, she submitted 18,765 fraudulent claims for reimbursement, which caused AHCCCS to pay CW Transport a total of $1,959,405.

On March 9, 2017, Werito pled guilty to Count 1 of the indictment, charging him with committing health care fraud. Werito admitted, as the sole owner of CW Transport, he submitted approximately 18,765 claims for reimbursement to AHCCCS between July 2011 and July 2013. Because the claims were grouped in 140 invoices, Werito received 140 payments from AHCCCS in an amount totaling $1,959,405. Werito admitted submitting the claims for reimbursement as part of a scheme to defraud AHCCCS because he either never provided or provided in a substantially different manner many of the services for which he sought and received reimbursement. On Sept. 6, 2017, Werito was sentenced to 30 months in prison followed by three years of supervised release, and was ordered to pay $1,218,165 in restitution to the victim of his criminal conduct.

The Albuquerque office of HSI investigated the case with assistance from the FBI, U.S. Marshals Service, San Juan County Sheriff’s Office, the Arizona Health Care Cost Containment System and New Mexico Office of the Attorney General. Assistant U.S. Attorney Jeremy Peña prosecuted the case.

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