Fraud Conductor

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In 2016, Medicaid paid out $26 million for individuals who were deceased, just in one state alone. The federal-state insurance program, which serves the nation ‘s most underprivileged citizens, has similar problems in other states as well. A Texas physician jumped on the fraud train and did his fair share of damage by billing deceased patients for services not rendered at his medical practices located in the Rio Grande Valley and in Corpus Christi.

The 68-year-old medical doctor (who should have known better) scammed the government healthcare program in multiple ways. He was paid thousands of dollars in kickbacks for referring Medicare beneficiaries over a two-year-period; he signed forms for patients he did not treat, some of which were deceased at the time; and, he caused other health service providers to illegally file claims, knowing the services claimed were never provided.

The former doctor pleaded guilty to conspiracy to commit healthcare fraud. Due to the guilty plea, prosecutors recommended a reduced sentence and to have the rest of the charges dropped, including aggravated identity theft and obstruction of criminal investigations of healthcare offenses. (Apparently, it is up to the doctor to accept the plea deal. Sounds like a good idea to me at his advanced age.)

At sentencing, he faces up to ten years in federal prison and a $250,000 fine. He may also be asked to pay more than $300,000 in restitution and serve three years of probation following his time behind bars. (It looks like this fraud train has run off the tracks and the fraud conductor has a one-way ticket to jail.)

Source: Today’s “Fraud of the Day” is based on an article entitled, “Mission doctor pleads guilty to Medicaid fraud,” published by The Monitor on February 7, 2017.

McALLEN ‚A Mission doctor accused of submitting false Medicaid claims for patients who were deceased pleaded guilty to the charges Tuesday.

Dr. Pedro Garcia, 68, went before federal District Judge Ricardo Hinojosa and pleaded guilty to conspiracy to commit healthcare fraud. In exchange for his guilty plea, prosecutors recommended the court reduce his sentence and drop the rest of his charges, including aggravated identity theft and obstruction of criminal investigations of healthcare offenses, but it is still up to Hinojosa to accept the government’s plea deal.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.