In Case You Missed It: Texas Attorney General Investigation Leads to Health Care Fraud Indictments
The following is a news release issued by the United States Attorney for the Southern District of Texas on July 29:
SUPERSEDING INDICTMENT CHARGES ROMELIA PUIG AND MISSION CLINIC STAFF WITH DEFRAUDING MEDICARE AND MEDICAID
McAllen, Texas A 13-count superseding indictment charging Romelia Sanchez Puig, 41, of Edinburg, Texas, and two staff members of the Mission Clinic in Mission, Texas, with conspiracy to commit health care fraud, health care fraud arising from a scheme to defraud Medicare and Medicaid from the operation of two clinics and mail fraud has been returned by a Corpus Christi grand jury, United States Attorney Jos Angel Moreno and Texas Attorney General Greg Abbott announced today.
The two Mission Clinic staff members, Eliza Lozano Lumbreras, 63, and San Juanita Gallegos Lozano, 54, both of Mission, Texas, were arrested this morning and are expected to appear before a U. S. Magistrate Judge in McAllen later today. Their release on bond is expected to be decided then. Romelia Puig, on bond since the return of the first indictment is expected to surrender herself to federal authorities on Friday, July 30, for arraignment on the new charges against her.
Puig was originally indicted along with her husband, Manuel Anthony Puig, 44, of Edinburg, Texas, on March 9, 2010, charged with health care fraud, mail fraud and conspiracy to commit health care fraud arising from their operation of the La Hacienda Family Clinic in Mission, Texas. The superseding indictment, returned by a federal grand jury on July 27, 2010, adds Lumbreras and Lozano as defendants to each of the original counts alleged in the first indictment along with Romelia Puig and adds charges accusing Lumbreras and Lozano of conspiracy to commit health care fraud and five new counts of health care fraud arising from the operation of the Mission Clinic. The superseding indictment also charges all three defendants with four additional counts of mail fraud arising from the operation of both clinics. The Medicare program is also identified as a victim of the alleged fraud scheme.
Puig, along with her husband, a physician assistant, operated La Hacienda Family Clinic in Mission, Texas. By state law, as a physician assistant, Manuel Puig was required to have a licensed physician supervising his work and delegating responsibilities to him. The original indictment accused the Puigs of fraudulently using the Medicaid provider number of R.J.P., a medical doctor who owned the Mission Clinic in Mission, Texas to fraudulently bill Medicaid for services performed by Manuel Puig without required delegation of authority nor supervision. According to the indictment, R. J. P.’s physical and mental condition prevented him from practicing medicine, and R. J. P. had not delegated authority to the Manuel Puig to see patients nor did he supervise Manuel Puig’s activities, yet beginning in or about May 1, 2005, through on or about Jan. 10, 2006, Manuel Puig provided medical care and services for Medicaid beneficiaries without the authority or the supervision of R.J.P. During the same time period, the Puigs alleged sent 6,000 claims to Medicaid fraudulently using the Texas Medical provider number for R.J.P. Medicaid paid over $173,000 as a result of these claims.
The superseding indictment alleges that between September 2001 and January 2006, R. J. P. was physically and mentally unable to practice medicine but that his office staff, Lumbreras and Lozano, kept the Mission Clinic open for patient care. Despite R. J. P.’s inability to practice medicine, the superseding indictment alleges Lumbreras and Lozano took him to the Mission Clinic where they placed him in an office while Lumbreras saw and treated patients. Neither Lumbreras or Lozano were licensed to provide any medical services. Between September 2001 and January 2006, Lumbreras and Lozano allegedly submitted bills to the Medicare and Medicaid programs which fraudulently claimed that R. J. P. had provided patients with over 7,000 medical benefits, items or services when in fact those services had been provided by Lumbreras or not at all. Medicare and Medicaid paid over $195,000 on those claims.
The indictment further alleges that Lumbreras and or Lozano arranged for Manual Anthony Puig to operate La Hacienda Family Clinic in Alton, Texas, beginning in April 2005 and to send bills to Medicare and Medicaid using the provider number of R.J. P. Romelia Puig allegedly did the billing for her husband and La Hacienda Clinic and also gave billing advice to Lumbreras and Lozano.
Lumbreras, according to the indictment, had power of attorney over R. J. P.’s finances and was able to obtain control over the money Medicare and Medicaid paid for the fraudulent bills submitted from the Mission and La Hacienda clinics, which was divided among Lumbreras, Lozano, and the Puigs. The clinic operated by the Puigs and the clinic operated by Lumbreras and Lozano are no longer in operation.
Conspiracy to commit health care fraud, and each count of health care fraud carries a maximum punishment of 10 years imprisonment upon conviction. Mail fraud carries a maximum punishment of 20 years imprisonment upon conviction. Maximum fines of $250,000 fine can also be imposed upon conviction for each count.
On July 23, 2010, Manuel Anthony Puig pleaded guilty before Chief United States District Judge Ricardo H. Hinojosa to the conspiracy charge of the original incitement and faces up to 10 years in prison and a $250,000 fine for the conviction. Mr. Puig, who is not charged in the superseding indictment, remains on bond pending an Oct. 26, 2010 sentencing hearing.
The investigation leading to the charges was conducted by the FBI and the Texas Attorney General’s Medicaid Fraud Control Unit with the assistance and cooperation of the Mission Police Department. Assistant United States Attorney Casey N. MacDonald and Special Assistant United States Attorney Rex G. Beasley are prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless and until convicted through due process of law.