A low-level employee at Unisys, the company that writes Medicaid checks for the state, has been accused of stealing more than $20-million that should have gone to help the poor and elderly.
Using the names of dozens of health care providers, the employee submitted false claims and had reimbursement money sent to rented mail drops, investigators said. Checks were cashed in the United States, Colombia and the Caribbean.
The arrest of Daniel Perez, 45, marks the second time in six months that a Unisys employee has been accused of bilking Medicaid. Unisys has contracts with Florida to process state employee health insurance claims and administer payments to Medicaid providers.
Perez was arrested on 65 counts of Medicaid fraud and computer fraud Monday night in Tallahassee and held in lieu of $335,000 bail. The charges involve checks totaling $1.2-million written to a Winter Park nose and throat specialist but sent to a Tampa address. Investigators said that the physician's name and provider number were used in the scam but that he did not receive any of the money.
Perez also faces the likelihood of federal charges for additional claims paid by Medicare for the same patients.
Perez was part of a larger organization that remains under investigation, said James T. Moore, commissioner of the Florida Department of Law Enforcement. Additional arrests are expected.
Asked about the Colombian connection, Moore would not say whether drug smuggling is involved. He did compare Perez's role in the scheme to that of an off loader, a person who takes a small boat out to a mother ship and transports drugs back to shore. Moore said Perez's accomplices are targets of the next phase of the investigation.
Doug Cook, secretary of the Agency for Health Care Administration, said Perez was discovered after officials in the fraud division of his agency noticed that checks were suddenly being sent to new addresses of doctors who had not submitted claims to Medicaid for a long time.
Investigators have traced $7.4-million in Medicaid billings directly to Perez and more than $15-million in billings to another group associated with Perez. Cook said taxpayers won't be out any money because Unisys will have to repay the state for any losses that cannot be recovered.
Moore said Perez, an ordained minister of the Church of God, was hired by Unisys as a temporary employee in September 1995 and retained as a permanent employee three months later. He worked as a customer service representative.
Perez had previously been fired by Consultec, the Tallahassee company that handled Medicaid payments before Unisys got the contract in 1994.
Officials at Unisys said they believe Perez was part of a sophisticated organization that could not be easily detected. But state officials questioned Unisys' internal security.
"My dissatisfaction with Unisys is pretty comprehensive," Cook said, noting that the company has been notified that its Medicaid contract probably will not be renewed when it expires in two years.
The investigation of Perez began last fall when officials at the health care agency noticed that 20 health care providers who had not billed the state since 1994 were receiving checks at new addresses.
Health care officials notified the state law enforcement agency, which was investigating other complaints against Unisys. Together with Attorney General Bob Butterworth's Medicaid fraud investigators and Statewide Prosecutor Melanie Hines they went to work to determine what was happening.
They discovered that Perez was working inside Unisys to get addresses changed so checks could be sent to mail drops. Some of the checks were cashed in Colombia, Puerto Rico, New York and Nassau. Others went to South Florida. All of the checks were cashed at check cashing facilities where the state checks were not questioned. Some of the checks were for as much as $99,000.
Moore said his agency has identified 89 other health care providers whose names were used by Perez to get checks disbursed. The 65 charges filed against Perez this week are only a fraction of the more than 5,000 counts of Medicaid fraud that could be made against him, Moore said.
Asked if any other officials at Unisys were involved in the scheme, Moore said: "Draw your own conclusions; he was an $8-an-hour employee."
Moore said Perez's arrest and the arrest last fall of Darien J. Reynolds, a temporary employee in the same office accused of stealing about $400,000, show the company needs to tighten security.
Reynolds was charged with falsifying checks he sent to his sister last year.
Regarding a separate probe into the way another Unisys division has handled health care claims filed by state employees, Moore said project director John Singleton has been invited to appear before the statewide grand jury but has refused.
Moore said Unisys cooperated in the Medicaid investigation, but has not cooperated with investigators looking at the employee health care contract.
"Every time we turn around we have a high class lawyer telling us who we can talk to," Moore said. "We had a former Unisys employee tell us that he was intimidated by the presence of a corporate lawyer he did not request. He was reluctant to tell us what he knows because of it."
Unisys officials were outraged at Moore's comments, but refused to explain Singleton's actions.
"Unisys is cooperating," said spokesman Rick Oppenheim. "It's inappropriate for anyone to say that he has refused to appear. We can't comment on activities involved in a grand jury investigation."
AKA/Daniel Perez Bermudez
+ 1991 moved to Tallahassee from Puerto Rico.
+ Ordained minister of the Church of God.
+ Member of the Executive Committee of the Church of God.
+ 1978-1980 Attended Interamerican University, Puerto Rico.
+ 1983-87 Attended Pentecostal Bible College, Puerto Rico, B.A. in Christian Education.
+ 9/13/91-4/28/93 Employed with Consultec, Tallahassee, as a communication specialist. Terminated due to personal telephone calls.
+ 9/11/95 Hired by Unisys as a temporary customer service representative.
+ 12/16/95 Hired as a permanent employee with Unisys.
How the scheme worked
Daniel Perez manipulated the system at Unisys to divert millions of dollars in payouts for Medicaid claims, according to Florida Department of Law Enforecement officials. Officials say the scheme worked this way:
Perez would get the names of medical providers who rarely filed claims and send in a change of address to Unisys.
Then Perez would get an electronic claims registration form from Unisys.
Perez would fill out the form and file it electronically to Unisys.
When it received the claims, Unisys would issue checks and mail them to the phony addresses on the claims forms.
Perez or an accomplice would pick up the checks and use check-cashing businesses including some in Colombia, Puerto Rico and the Bahamas that weren't vigorous in checking identification.