U.S. Department of Labor Investigation Results in U.S. District Court Sentencing Louisville Health Clinics’ Co-Founder to Prison, Ordering $258,507 Restitution Payment for Healthcare Fraud

LOUISVILLE, KY – After an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA), the U.S. District Court for the Western District of Kentucky has sentenced Eduardo Chinea Martinez – co-founder of several Louisville, Kentucky, medical clinics – to 42 months in prison and three years of supervised release. The court also ordered him to pay $258,507 in restitution for defrauding healthcare benefit programs. He made full restitution on March 5, 2020, the date of sentencing.

The court’s action follows Martinez’s August 2019 guilty plea to one count of conspiracy to commit healthcare fraud, 16 counts of healthcare fraud, 13 counts of theft in connection with healthcare valued at $258,507, 13 counts of aggravated identity theft, 10 counts of money laundering and four counts of mail fraud.

EBSA investigators found that Martinez participated in a fraudulent scheme by establishing Romero Rehabilitation Physical Therapy Inc., Empire USA Inc. and Imaging Group Center Inc. and then billing Humana, CIGNA and United Healthcare for medical services the clinics never administered. The insurance companies billed private-sector employee welfare benefit plans for the false charges and the private-sector employee welfare benefit plans paid a portion of the false charges.

Investigators also found that Martinez unlawfully used the identification of medical providers on billing statements, alleging the medical providers administered the false services to patients.

“Knowingly committing healthcare fraud victimizes insurance companies and hardworking employees,” said Employee Benefits Security Administration Regional Director L. Joe Rivers, in Cincinnati, Ohio. “Fraudulently inflating healthcare bills for unnecessary or non-existent treatments increases the cost for others in need of health insurance. The U.S. Department of Labor remains committed to preventing benefits abuse and hold anyone found guilty of fraud accountable.”

Employers and workers can reach EBSA toll-free at 866-444-3272 for help with problems related to private sector retirement and health plans. Additional information can be found at http://www.dol.gov/ebsa.

EBSA’s mission is to assure the security of the retirement, health and other workplace related benefits of America’s workers and their families. EBSA accomplishes this mission by developing effective regulations; assisting and educating workers, plan sponsors, fiduciaries and service providers and vigorously enforcing the law.

The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.