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Joelle Embres' Blog

By Joelle Embres | Agent in Parkland, FL

School employees busted in insurance scam

MIAMI (WSVN) -- Several local school employees have been arrested, accused of trying to cash in on a medical insurance scam.

The State Attorney's Office released details of the arrests Thursday afternoon during a press conference. The scheme stemmed from a practice called patient brokering, when a clinic will actually pay people to come to a clinic and then, in order to make up for that money as well as make a profit, that clinic will bill the insurance company for all sorts of procedures that never happen. The big loser in this: the Miami-Dade School District.

Earlier that day, Yasiel Reyes Gonzalez went before a judge. "Yasiel Reyes Gonzalez is, as I said, the mastermind behind this coordinated theft," said State Attorney Katherine Fernandez-Rundle.

At just 23 years old, Gonzalez is the owner and operator of the Opera Health Clinic, located at 2141 SW 1st St. Investigators said it was from that clinic that he and at least two others bilked the Miami-Dade School Board out of at least $1 million. Miami-Dade Public Schools Superintendent Alberto Carvalho said, "It is shameful, it is unacceptable."

Investigators said, Cynthia Dasilva, an employee of Gonzalez who also happens to work as a Miami-Dade School bus driver, along with another bus driver, Maria Mendez, would bring in other school employees. Most of those employees were also bus drivers. They would promise them $800 in cash to visit as a patient, whether they were sick or not. They would also offer $50 to refer someone else. "And then, their name and their insurance claim number would be used for a bunch of services that were never performed," explained Fernandez-Rundle.

Undercover video captured Dasilva making one of those deals.

As the school district is self-insured, that means the clinic charged the school system thousands of dollars for appointments. "It was a betrayal," said Fernandez-Rundle. "It was a betrayal to our superintendent. It was a betrayal to our children and our schools."

Miami-Dade Schools Police Chief Charles Hurley added, "We fight like hell to balance this budget and increase academics and insure our school system is vibrant, and for this to happen is a complete slap in our face."

Officials said they expect to make more arrests as the investigation continues, and they feel the thefts could total as much as $3 million. The SAO said they want to hear from anyone involved now before they catch up with them: Call 305-547-3300 if you were involved in any of these scams.


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