Texas Company Sentenced in $11m Medicare Fraud Scheme

Texas Company Sentenced in $11m Medicare Fraud Scheme

The Medical Director of A Medical House Calls (A Medical), a Texas-based medical house call company for Medicare recipients, was sentenced to federal prison for a health care fraud conviction. According to a press release from the Texas Attorney General obtained by Breitbart Texas, A Medical billed taxpayers $1.4 million for services that were not needed or were never provided between May 2010 and January 2012. The fraudulent bills resulted in home health agencies charging an additional $9.7 million to the Medicare program. 

A Medical was located in three Texas cities–Mesquite, Dallas and Carrollton. According to an indictment filed in October 2012, Lawrence Dale St. John formed the company to certify Medicare beneficiaries for home health services. The company did this by sending physicians to people’s homes, specifically to homes of individuals using Medicare, as an alternative to going to a doctor’s office. A Medical did not provide primary care services, according to the filing. 

A Medical submitted a number of deceitful claims using the Medicare number of the company’s Medical Director, 54-year-old Dr. Nicolas Alfonso Padron. Padron, who consented to the use of his unique number for fraudulent purposes, joined A Medical in December 2009 according to files.

Padron, along with 67-year-old Lawrence Dale St. John and son, A Medical chief operations officer 42-year-old Jeffrey Dale St. John, billed Medicare for repeated bogus services, according to the U.S. Attorney for the Northern District of Texas. At times, such claims were sometimes submitted to Medicare while Padron was on vacation and out of the country, according to the court record. 

The St. Johns ordered employees to “pull patient charts and write in information including the date, what type of oversight was performed, and the minutes spent on oversight,” the indictment said. “All of the information indicated that Padron had performed these services, when in fact he had not conducted any.” 

A Medical would certify unqualified individuals for Medicare on a regular basis. “Once the company established a new patient and conducted a home visit… [it] would submit billing for fraudulent claims,” the indictment stated. 

Padron was sentenced to 57 months in federal prison on Tuesday after being convicted of one count of count of conspiracy to commit health care fraud according to the State. He also must pay $9,484,111 in restitution.

Lawrence Dale St. John and Jeffrey Dale St. John have a sentencing hearing scheduled for March 31 according to General Abbott’s office. They are each charged with one count of conspiracy to commit health care fraud and 13 counts of healthcare fraud.

Padron Indictment by BreitbartTexas

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