Criminal Justice News

Monday, October 01, 2012

Former Clinic Staffers Convicted in Health Care Fraud Conspiracy

MCALLEN, TX—Eliza Lozano Lumbreras, 65, and San Juanita Gallegos Lozano, 56, both of Mission, have entered pleas of guilty to conspiracy to commit health care fraud arising from a scheme to defraud Medicare and Medicaid in the operation of the Mission Clinic and La Hacienda Family Clinic, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott. The pair, who are related by marriage, both pleaded guilty today at the start of the seventh day of trial in McAllen.

Although the government had not concluded its case, six days of testimony had been presented showing Lumbreras and Lozano conspired together and with others to submit claims to Medicare and Medicaid. Evidence proved they fraudulently used the Medicaid provider number of a medical doctor who for years before his death, was unable to practice medicine. Treating doctors provided testimony that the doctor suffered from Parkinson’s disease and associated dementia and had been mentally incompetent to practice medicine since September 2001.

Jurors heard testimony that although the doctor was physically and mentally unable to practice medicine, Lumbreras and Lozano kept the Mission Clinic open for patient care. Lumbreras and Lozano took the doctor to the Mission Clinic and placed him in an office while Lumbreras saw and treated patients. Neither Lumbreras nor Lozano was licensed to provide any medical services. The government’s evidence showed that between September 2001 and January 2006, Lumbreras and Lozano submitted bills to the Medicare and Medicaid programs which fraudulently claimed the doctor had provided patients with more than 13,000 medical benefits, items, or services when, in fact, those services had been provided by Lumbreras or not at all. As a result, Medicare and Medicaid paid more than $344,000 on those claims.

Beginning in April 2005, Lumbreras and Lozano also arranged for Manual Puig, a physician assistant, to operate La Hacienda Family Clinic in Alton and to send bills to Medicare and Medicaid using the provider number of that same unpracticing doctor. By state law, as a physician assistant, Puig was required to have a licensed physician supervising his work and delegating responsibilities to him.

Further, Lumbreras had access to the doctor’s bank accounts 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, their families, Puig, and Puig’s wife Romelia Puig.

Romelia Puig, 44, and Manuel Anthony Puig, 45, both of Edinburg, pleaded guilty in advance of trial and are awaiting sentencing. All defendants remain free on bond. Sentencing for Lumbreras and Lozano is scheduled for December 28, 2012.

La Hacienda Family Clinic and Mission Clinic are no longer in operation.

Conspiracy to commit health care fraud carries a maximum punishment of 10 years’ imprisonment and a maximum fine of $250,000.

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.

No comments: