STATE OF COLORADO. Walk-Through Authorized Q COUNTY OF BOULDER DA. COUNTYIDISTRICT COURT, BOULDER COUNTY, COLORADO. Criminal Action Number, ve 0) Aiedt 0D? Sr WARRANT FOR ARREST UPON AFFIDAVIT verore rienioxonaots _tadreed Mucdonsl A eee ‘The People of the State of Colorado, To: Any porson authorized by law to execute arrest warrants, ‘You are hereby commanded toarest the person of: erva Roman-Romero : Dos: 7/15/85 HAIR Brown HEIGHT: 52" EYES. Brown WEIGHT: 190 Ibs RACE/SEX: Hispanic female DL#: CO SSN: ALIAS: Nohemi Sarabia ALIAS DOB. OFFENSE DATE: 2000-Present mmecessary delay before the nearest judge of the Court of Record; to be advised that the ‘And take the person above-named withot In Violation of C.RS., 1973 revised: ‘person is being held forthe alleged commission of the following crime(s),to-wi ‘Charge# CRS # Charge Classification 1 18-4401 ‘TheR $100,000- one Million B M@RK) 2 185-113 Criminal Impersonation F6 cman ‘That this warrant for arrest is issued upon affidavit sworn to and affirmed before this court and relating facts sufficient to establish ‘probable cause that the above-named offense has been committed and probable cause that the person named in this warrant committed that offense. ~ ce GE YO palLissetats_{O, 020 WITH CONDITIONG), DATE: _Gep2iS bl ige's Signature Boulder Potice Case: P15-4662 Detective Cravitz 303-441-3345 RETURN OF SERVICE hereby certify that 1 have duly executed this warrant on this _ 20. by eee as am herein commanded, ‘SHERIFF FEES: Service S, Mileage §. By: Rewm Deputy‘AFFIDAVIT FOR ARREST WARRANT The Affiant (hereafter referred to as “I"), Detective Cravitz, is a duly commissioned Police Officer for the City of Boulder, located in the County of Boulder, State of Colorado, being duly sworn, deposes and states: ‘1am currently assigned to the Detective Section of the Boulder Police Department and investigate crimes occurring within the City of Boulder, County of Boulder, and State of Colorado. | was assigned the follow-up to P15-4663 reference a Fraud at Boulder Community Hospital. | spoke to Amber Jewett, Patient Access Supervisor and learned the following: On 4/15/15 a woman identifying herself as “Minerva Roman-Romero” came into the Heart clinicat 4747 ‘Arapahoe Ave City/County Boulder, State of Colorado and requested a name change on her patient fle, Minerva claimed that she was the patient they knew as “Nohemi Sarabia”. She wanted her medical records to reflect her correct name and date of birth, At that time, nothing was changed in the patient file and this was referred to Jewett to investigate. Im reviewing the medical records of Nohemi Sarabia, Jewett discovered that all of her medical care was Classified under “WE Care”, which is Boulder Community Hospital's charity care. This discounted care rogram is given to people who meet specific requirements. Under the We Care program, “Nohemi” Still owes the hospital $959.00. Jewett did the calculations and found that if Nohemi did not receive WE Care, her bills would have been $494,893.88, ‘The following is @ break-down of the outstanding balance of Nohemi Sarabla: Date Type of Visit Amount 2/28/2000 ER Visit $3,250.50 6/4/2002 ER Visit $263.00 5/2/2007. ER. $2,243.00 = 10/24/2009 Routine Care $48.56 2/25/2010 In Patient Stay $91,706.10 3/7/2010 in Patient Stay $11,803.64 5/10/2010 ER Visit $5,746.00 5/24/2010 ER Visit and Stay $20,312.95 1/30/2011 ER Visit and Stay 914,719.95 2/3/2011 Pacemaker and inpatientvisit $114,144.59 4/34/2011 £R Visit $3,048.00 10/29/2011 ER Visit and Stay $32,655.75 10/31/2011 ER Visit $16,962.00 4/16/2012 Outpatient Lab $464.00 5/14/2012 Outpatient Lab and other work $20,277.95 5/15/2012 ER Visit $5,790.65 6/4/2013 ER Visit $2,809.0011/23/2013 ER Visit $3,767.00 2/26/2014 ERVisit and Stay $100,466.66 3/5/2014 ER Visit and Stay $43,671.58 3/25/2014 Outpatient Lab $130.00 11/6/2014 Outpatient Lab $272.00 3/30/2015 Outpatient Lab $343.00 Total $494,893.88 Boulder Community Hospital records identified Nohemi Sarabia as: 0B 7/19/55 Social Security Number 3003 Valmont Rd # 228 Boulder, CO 80301 Boulder Community Hospital records identified Minerva Roman-Romero as: 0B 7/19/55 Social Security Number 3003 Valmont Rd # 228 Boulder, CO 80301 4 an the social security number used by Nohemi and it was associated with two different individuals living in South Carolina, | then ran the social security number associated with Minerva and found that it listed to Sandra Cagle of Fountain; CO. | spoke to Cagle and informed her about this investigation. She had no knowledge of anyone using her social security number. ‘The woman claiming to be Minerva keeps showing up at Boulder Community Hospital, demanding that her medical records be changed. She presented Colorado Driver's license # with a DOB: 7/29/55. Minerva told the hospital that she wants to travel to Mexico via plane, but because the information.on her Pacemaker.dentifies.her-as Nohemi-Sarabia, she will not be allowed.on the plane.— Minerva admitted that she made up the identity of Nohemi so she could receive care. (On §/6/15 at 1030 hrs | received a cali from Jewett. She advised that Minerva was at the hospital and she requested that I respond. Jewett and I met with Minerva and her boyfriend, Leo Soto, in Jewett’s office. Minerva did not speak English, so Leo provided the translation. Minerva came to the United States in 1999 from Veracruz, Mexico. She had a Vise, however, she has always worked in Colorado under the name Nohemi Sarabia, with a made up social security number. She has worked in different places; Taco Bell, University of Colorado, Whole Foods. Leo stated this was ‘common practice for people coming from Mexico because social security numbers are needed in order to work. They are taught to make up names and social security numbers so they don't jeopardize the information on their Visas.| asked Minerva to explain why she did not present herself as “Minerva” when she came to the hospital for the Pacemaker. She stated that she had an accident while working at Whole Foods and she had to {90 to the hospital. Because Whole Foods knew her as Nohemi, she had to stick with that name once she arrived at the hospital. This explanation did not make sense; because Jewett pointed out that she had found medical records under the name Minerva Roman-Romero. Minerva stated she was working at a bakery and she had an accident and they brought her to the hospital. She thinks she gave her name as Minerva at that time. She stated that she invented the social security associated with that hospital visit Minerva reported that she recently received a Green Card, She presented a social security card with the number .. She claimed she explained her two identifies to Immigration during her Green Card application. Jewett and | explained to Minerva that she received discounted/charity care under a false name. She stated that she had made payments when she had the money. Jewett pointed out that she might have been making co-payments to her doctor, but that had nothing to do with her outstanding hospital bill Jewett also pointed out that Minerva would not have qualified for We Care because she was employed. | told Minerva that I needed to continue my investigation and | would call her (through Leo) when it was complete. ‘Since our meeting, | have learned that Minerva has returned to the hospital many times, demanding that the records be changed, Jewett advised that Boulder Community Hospital wants to move forward with pressing charges. { believe that sufficient probable cause exists to believe that Minerva Roman-Romero with a date of birth of 7/19/55, and is further described as a Hispanic female who is 5'2” tall, 190 pounds with Brown. hair and Brown eyes with a social security number of ‘and the crime(s) of Theft, Criminal Impersonation as outlined in C.R.S. 18-4-404 (1}(a(2Mi, 18-5-113 (1)(b)(U) as amended. | respectfully request that a warrant be issued for Minerva Roman- Romero with a date of birth of “7/19/55; Biowi fair and brown éyes with a Social Security number of ‘committed the — crimes of ‘inal Impersonation, a class 3 Felony, class 6 Felony Affiant ‘Sworn to before me and subscribed in my presence this I7¥* sovot_ Maye 2S in the City of Boulder, County of Boulder, and the State of Colorado, Judge/Notary wd My commission expires: RENEE J MCCOY NOTARY PUBLIC ‘STATE OF COLORADO NOTARY 10 20024004208 [MY COMMISSION EXPIRES JULY 29,2010