Friday, October 18, 2013
DALLAS A federal jury has convicted two local men on conspiracy and health care fraud charges related to their operation of a physician house call company in North Texas, announced U.S. Attorney Sarah R. Saldaa of the Northern District of Texas.
On October 4, 2013, following a five-day trial before U.S. District Judge David C. Godbey, Lawrence Dale St. John, 66, and his son, Jeffrey Dale St. John, 41, both of Grand Prairie, Texas, were convicted on conspiracy and health care fraud charges related to their operation of A Medical House Calls, a physician house call company.
Specifically, each defendant was convicted on one count of conspiracy to commit health care fraud and 13 substantive counts of health care fraud. Each count carries a maximum statutory sentence of 10 years in federal prison and a $250,000 fine. Restitution could also be ordered. Judge Godbey remanded Jeffrey St. John into custody; Lawrence St. John was already in custody. Sentencing is set for January 27, 2014.
Co-defendant Dr. Nicolas Alfonso Padron, 54, of Garland, Texas, pleaded guilty on September 10, 2013, to one count of conspiracy to commit health care fraud. Dr. Padron, who joined A Medical as its medical director in December 2009, testified, as did a number of nurse practitioners, physician assistants and company staff, that services billed had never been performed.
In a separate case, Dr. Padron also entered a guilty plea to one count of conspiracy to unlawfully distribute a controlled substance stemming from his operation of Padron Wellness Clinic, a pill-mill, that he operated in Dallas. Dr. Padron has been in custody since his arrest in June 2012 on a related federal criminal complaint.
A Medical provided physician visits to Medicare beneficiaries in their homes rather than at a doctor’s office. A Medical, which was also known as A+ Medical House Calls and ANM Physician House Calls, was owned by Lawrence St. John; Jeffrey St. John ran its daily operations. A Medical had locations in Mesquite, Texas; Dallas; and Carrollton, Texas. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient.
Once A Medical established a Medicare beneficiary for physician home visit services, A Medical would submit billing for fraudulent care plan oversight claims. The company didn’t provide primary care physician services to Medicare beneficiaries.
According to documents filed in the case and evidence presented at trial, from May 2010 to January 2012, the defendants conspired together and with others to defraud the Medicare program. A Medical, at the direction of Lawrence and Jeffrey St. John, submitted claims to Medicare using Dr. Padron’s unique Medicare number, with Dr. Padron’s permission, regardless of the claim’s merit.
The defendants conspired together to bill Medicare for care plan oversight by Dr. Padron for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise.
In total, the defendants billed taxpayers for $1.4 million of services that were either not medically necessary or not rendered at all. Through the fraudulent certifications, Medicare was billed an additional $9.7 million by home health agencies.
The investigation was conducted by U.S. Department of Health and Human Services - Office of Inspector General, the FBI and the Texas Attorney General's Medicaid Fraud Control Unit.
Assistant U.S. Attorneys Kate Pfeifle and J. Nicholas Bunch are in charge of the prosecution.