McALLEN, Texas ‐ Federal charges have been filed against two individuals in separate cases for defrauding Texas Medicaid and/or Medicare in two separate schemes to defraud through false billings, announced U.S. Attorney Kenneth Magidson.
Manuel Gomez, Jr., 34, of Katy, owned two Rio Grande Valley area durable medical equipment (DME) companies, while Elva Santos, 36, of McAllen, owned Hope & Miracle DME in Mission.
A sealed indictment against Gomez was returned March 29, 2015, and unsealed today upon his arrest. He is expected to make an initial appearance in Houston before U.S. Magistrate Judge Stephen Smith at 10.00 a.m. tomorrow. Santos was charged in an unsealed information and is set for her appearance April 8, 2016, at 10:30 a.m. before U.S. Magistrate Judge Peter Ormsby.
Both are charged separately in difference cases but in similar schemes to defraud and sent false and fraudulent claims regarding DME, specifically incontinence supplies and diabetic supplies.
In his case, Gomez and/or his co-conspirators sent such claims totaling approximately $2,347,841.71 to Texas Medicaid, on which Texas Medicaid allegedly paid out $2,088,473.67, according to the indictment. Santos allegedly submitted false and fraudulent claims for $713,759.73 on which Texas Medicaid paid out $581,743.39. To conceal their schemes, both forged and/or caused others to forge the signatures of physicians on the required DME prescription forms also known as Title XIX forms.
Gomez owned Illusion Medical Equipment and Illusion Medical Equipment II LLC and is charged with one count of conspiracy to commit health care fraud, six counts of health care fraud and one count of aggravated identity theft.
The indictment alleges that Gomez conducted his scheme from Dec. 1, 2007, to Nov. 30, 2011. Gomez and his co-conspirators were allegedly responsible for the submission of false and fraudulent billings and the misuse of the identifying information of Texas Medicaid recipients. Gomez also allegedly paid illegal kickbacks in exchange for patient information, including patient Texas Medicaid numbers. He and/or his co-conspirators would then use the fraudulently obtained Texas Medicaid numbers to submit claims to Texas Medicaid in order to receive reimbursements.
In the separate, yet similar case against Santos, from Jan. 20, 2011, to May 10, 2013, she allegedly submitted the false and fraudulent claims. In one instance alleged in the information, Santos submitted or caused others to submit false or fraudulent claims with Medicare for a patient who was deceased on dates that Santos claimed to have provided diabetic supplies to the patient. The delivery tickets maintained by Hope & Miracle DME contained forged signatures of the deceased beneficiary after the date of her death.
Health care fraud carries a maximum punishment of 10 years in federal prison without parole and a $250,000 fine upon conviction. If convicted of the identity theft, Gomez also faces a mandatory 24 months which must be served consecutively to any other prison term imposed. The Texas Attorney General’s Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services‐Office of Inspector General conducted the investigation. Assistant U.S. Attorney Michael Day is prosecuting the cases.
An indictment or information are accusations of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.