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Friday, November 15, 2019

Texas duo charged for fraudulent medical billing scheme

By Nick Rees | Oct 24, 2013


McALLEN, Texas (Legal Newsline) - Two Mission, Texas, residents were charged in a federal indictment this week over allegations of their roles in a scheme meant to defraud Medicare and Texas Medicaid through fraudulent billings.

Texas Attorney General Greg Abbott and United States Attorney Kenneth Magidson announced the indictments, returned on Oct. 15 and unsealed following their arrests on Oct. 18, against Frank Gonzalez and Graciela Escamilla. The pair made their initial appearance in federal court on Oct. 18 before appearing for an arraignment and detention hearing Thursday. The two were permitted release upon posting a $50,000 bond.

A trial is set for Dec. 3.

Gonzalez, the owner of River Valley Transport, doing business as Med-Alert EMS, and Escamilla, the owner of RioPlex Billing Solution, are each charged with one count of conspiracy to commit health care fraud, seven counts of health care fraud and one count of aggravated identity theft. In addition, Gonzalez faces one count of mail fraud.

According to the indictment, Gonzalez allegedly engaged in and directed a scheme from June 2007 to February 2011 to submit false and fraudulent claims to Medicare and Texas Medicaid for ambulance transportation services in the McAllen area that were not provided.

Escamilla, serving as a biller for Gonzalez and his company, allegedly participated in the scheme and aided Gonzalez by submitting false and fraudulent buildings and stealing a beneficiary's identity.

The pair's actions allegedly resulted in approximately 1,524 false and fraudulent claims that totaled approximately $638,090. The allegedly false and fraudulent claims for ambulance transportation services for dialysis patients were sent to Medicare and Texas Medicaid.

In addition, the indictment alleges that more than $335,000 was paid out by Medicare and Texas Medicaid on the false and fraudulent claims.

To conceal the fraud, the defendants allegedly created phony transportation records and signatures of individuals on documents.

The two face a maximum punishment of 10 years in federal prison for the conspiracy to commit health care fraud and each of the seven counts of health care fraud, while the mail fraud count has a possible 20-year sentence. The charges also carry a possible $250,000 fine.

If convicted of aggravated identity theft, a mandatory two-year additional prison term must be served consecutive to any other prison sentence imposed.

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