Miami Man Sentenced to Over 5 Years in Prison and Ordered to Pay Over $3.8 Million for Fraudulently Billing Medicaid for Psychosocial Rehabilitation Services

Jose Davila Nunez, 51, of Miami, was sentenced on Oct. 11, to 63 months in federal prison to be followed by three years of supervised release for Medicaid fraud.  Davila was also ordered to pay $3,869,703 in restitution.

Davila pled guilty to conspiracy to commit health care fraud on June 14.  According to the court record, to include the agreed upon factual proffer, Davila and his co-conspirators opened a mental health clinic called New Behavior Health Direction, Incorporated (New Behavior) located in Hialeah Gardens, Fla. and installed a nominee owner. Between April 2019 and September 2020, Davila and his co-conspirators submitted $3,869,703 in false claims to Medicaid for psychosocial rehabilitation (PSR) services, a type of mental health counseling designed to help people with depression, anxiety, and other mental disorders.  In September 2020, the nominee owner helped to withdraw the fraud proceeds, gave some of that money to Davila, and then the nominee owner fled to Cuba.  Davila’s company Max Medical Consulting Services, Incorporated of Miami, Fla. received approximately $500,000 in fraud proceeds from New Behavior.

At the sentencing hearing, Davila was also held accountable for an additional $2,617,992 related to Davila and his co-conspirator’s conduct in paying illegal bribes to patients between November 2018 and December 2022 in exchange for PSR services at three other Miami clinics.  Those three clinics are Davila Medical Center, Incorporated, Advanced Community Wellness Center, and Larkin Behavior Health, Incorporated.

The U.S. government was able to seize approximately $1.7 million in cash related to New Behavior’s bank accounts.

U.S. Attorney for the Southern District of Florida Markenzy Lapointe; Special Agent in Charge Stephen Mahmood of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Special Agent in Charge Jeffrey B. Veltri of the FBI, Miami Field Office, and Florida Attorney General Ashley Moody for the Florida Office of the Attorney General Medicaid Fraud Control Unit (MFCU) made the announcement.

HHS-OIG Miami, FBI Miami, and MFCU investigated this case. AUSA Timothy Abraham prosecuted the case. Assistant U.S. Attorney Jorge Delgado is handling asset forfeiture.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov  or at http://pacer.flsd.uscourts.gov under 23-cr-20390.