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Feds Crack Down on Medical Fraud Near Texas Border

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Federal authorities have begun a large-scale crackdown on healthcare businesses and doctors along the Texas border who are accused of scamming government health care programs.

This week, authorities have arrested seven health care professionals in the border city of McAllen, all accused of being part of various billing and kickback schemes – some of which were coordinated in order to make fraudulent claims on the federally-funded Medicare and Texas-funded Medicaid programs, court records obtained by Breitbart Texas revealed.

The Texas border has historically been one of the poorest areas in the country, with a large number of its residents requiring government assistance for medical care. That government assistance is what prosecutors claim several health-care professionals used as their personal gold mine.

In the first case, federal prosecutors obtained a sealed indictment, of which Breitbart Texas obtained a copy, against Martha Lidia Flores and Argentina Cavazos. Flores is described by prosecutors as a marketer for various home health companies, while Cavazos was described as a medical assistant at a local doctor’s office.

Cavazos is accused of selling patient information to Flores, who in turn would use the information to submit false forms to her companies for services. Cavazos is believed to have received about $3,000, while Flores is believed to have obtained forged doctor signatures to bill more than $155,000 in fraudulent services to Medicare, for which she was paid referral fees.

In another case, local doctor Eduardo Carrillo and his assistant Martha Uribe Medrano are accused of taking $3,000 bribes from home health care agencies in exchange for patient referrals, so the companies could bill the government for services that were not needed, and at times not even rendered. The criminal indictment obtained by Breitbart Texas details the method used to collect these kickbacks.

A third case saw Ricardo Mendez, a registered nurse and owner of Palm Valley Family Clinic, and Ermit De la Torre arrested and charged with various fraud counts for their alleged role in a billing scheme, as another indictment obtained by Breitbart Texas revealed.

According to prosecutors, Mendez and De la Torre are accused of billing the government for close to $50,000 in medical services that were not performed by a medical professional. According to the authorities, De la Torre presented herself as a doctor (La Doctora), performed a series of exams on patients, and filled out prescriptions, even though she is not licensed to perform medical services in Texas. The prescriptions were blank ones that had been signed beforehand by Mendez.

In a fourth case, prosecutors went after Veronica Vela, the owner of ABC DME, and her biller Cynthia Zapata, another indictment obtained by Breitbart Texas revealed. Prosecutors in this case allege that from 2006 to 2013, ABC DME submitted close to $5 million in fraudulent bills, and were paid about $3.5 million. The company would bill the government for durable medical equipment that was not provided, as well as submitting exaggerated bills for items such as diapers and pads, which the patients never received.

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