San Juan Star
Noted Psychiatrist Among Those Held for Workers’ Comp Fraud
By MARIA MIRANDA SIERRA
September 6, 2013
Renowned psychiatrist Alfonso Madrid was one of the people arrested during a federal raid Thursday morning related to federal program fraud at the U.S. Labor Department, U.S. Attorney for the District of Puerto Rico Rosa Emilia Rodríguez announced at a news conference in the Hato Rey sector of San Juan.
Madrid, a well-known and respected doctor in Puerto Rico, is best known for his evaluation of the sexual assault victim in the case of former San Juan Security Commissioner Hilton Cordero. Madrid recommended to the Carolina Courthouse that the girl could testify against her aggressor, but in a closed-circuit system, as she didn’t want anybody to know she was the victim of the sexual abuse nor did she want her face to be shown to the media. The victim agreed to the terms of privacy and gave her testimony.
The girl was Cordero’s neighbor and a friend of his oldest daughter. Cordero took advantage of her family’s economic situation, offering to pay her for nude photos, which she took and would send to him through a cellular phone he provided.
Cordero also allegedly had sexual encounters with the girl, a minor, for a prolonged period of time.
Madrid also collaborated with a local radio station, offering a segment on human conduct.
At the news conference, Rodríguez said a federal grand jury returned 12 separate indictments, including Madrid’s, charging 10 current and former U.S. Postal Service (USPS) employees and Dr. Luis Faura with fraud associated with Department of Labor (DOL) Office of Worker’s Compensation Program (OWCP). The program provides wage loss and medical benefits to workers who have become injured in the course of their official capacity within the USPS and are unable to work due to disability.
“The Department of Justice is strongly committed to promoting compliance with federal program laws and regulations,” Rodríguez said. “These arrests demonstrate that we will not tolerate criminals who engage in fraudulent schemes that deplete the funds of federal benefit programs, which are destined for disabled individuals who really need and are entitled to them. We will continue to 0vigorously pursue this systemic problem.
A two-year investigation led by the USPS Office of Inspector General (OIG), with assistance from the FBI, Social Security Administration OIG, Health and Human Services OIG, the DOL-OIG and the Puerto Rico Police Department targeted fraud associated with OWCP claims, Rodríguez said.
“Postal Service employees are covered by the Federal Employees’ Compensation Act (FECA), which provides tax-free benefits to civilian federal employees who sustain injuries or an occupational disease as a result of their employment,” Rodríguez said. “Postal employees can receive up to 75 percent [compensation] if there is at least one dependent. The Postal Service is the largest FECA participant, paying more than $1 billion in benefits and $60 million in administrative fees annually.”
According to OWCP guidelines, claimants must prove that they are disabled by furnishing medical documentation and other evidence with their work-related claim. The employee’s claim and supporting medical evidence are then evaluated by the OWCP to determine the claimant’s medical impairments and the effect on the claimant’s ability to work.
“Today’s arrests highlight the OIG’s commitment to investigating fraud against the federal employees’ compensation program, which provides workers’ compensation coverage to federal employees for work-related injuries and illnesses,” Acting Deputy Inspector General of the U.S. Department of Labor Gordon Heddell noted.
Initially the probe focused on Dr. Faura and the medical documentation he filed supporting the permanent disability of USPS claimants. Subsequently, the investigation revealed Faura and Madrid would falsely evaluate and diagnose claimants in an effort to deceive and persuade the OWCP to award the claimants with workers’ compensation benefits. The doctors would charge fees ranging up to $1,650 for the preparation of the fraudulent medical reports.
During the investigation, additional evidence revealed six of the 10 aforementioned OWCP claimants also fraudulently received Social Security Administration Disability benefits.
“We are proud to be a part of the federal team that brought these defendants to justice for defrauding Medicare by illegally enrolling in the Program,” said Thomas O’Donnell, Special Agent in Charge of the Office of Inspector General’s New York Regional Office, which also covers Puerto Rico.
The defendants who illegally received the workers’ compensation benefits are: Bernardo Brito, Rodolfo Vázquez, Félix Ortiz, Miguel Plaza, Wilma Fontán, Moisés Rivera, Samuel Badillo, Ricardo Rivera, Rafael Espinet and Lydia Rivera. All the defendants are facing forfeiture allegations totaling more than $620,000.
In addition, Brito is also charged with health care fraud.
“Today’s indictments should send a clear message to doctors and Postal employees that defrauding the federal workers’ compensation program will not be tolerated,” said Rafael Medina, Special Agent in Charge of the Postal Service Office of Inspector General. “Anyone who helps Postal employees commit workers’ compensation fraud should know this is only the start of our investigative efforts to expose these false claims.”
The case was investigated by the USPS-OIG with the collaboration of the FBI, aforementioned OIGs and the Puerto Rico Police Department. Indictments were prepared by First Assistant U.S. Attorney María Domínguez.