Tuesday, July 27, 2010

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In Case You Missed It: Texas Attorney General Investigation Leads to McAllen Medicaid Fraud Conviction

The following is a news release issued by the United States Attorney's Office for the Southern District of Texas on July 26, 2010:

PHYSICIAN’S ASSISTANT CONVICTED OF CONSPIRING TO DEFRAUD MEDICAID

(McALLEN, Texas) – Local Physician Assistant Manuel Anthony Puig, 44, has plead guilty to conspiracy to defraud the Texas Medicaid program, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today. Manuel Puig, doing business as Puig Medical Services, operated La Hacienda Family Clinic, near Alton, Texas.

Indicted by a federal grand jury on March 9, 2010, for health care fraud, mail fraud and conspiracy to commit health care fraud, Puig pleaded guilty before Chief United States District Judge Ricardo H. Hinojosa on Friday, July 23, 2010, to the conspiracy charge and faces up to 10 years in prison and a $250,000 fine for the conviction.

By state law, as a physician assistant, Manuel Puig is required to have a licensed physician supervising his work and delegating responsibilities to him. At today’s hearing, Manuel Puig admitted that in 2005, he joined an ongoing conspiracy with others to submit claims to the health care benefit program known as the Texas Medicaid program. Puig admitted fraudulently using the Medicaid provider number of R.J.P., a medical doctor who, for some time before 2005 until his death, was physically and mentally unable to practice medicine nor provide any health care benefits, items or services; who did not delegate authority to Manuel Puig to provide any health care benefits, items or services; and who did not supervise Puig’s attempts to provide health care benefits, items or services.

Puig admitted that he furthered the conspiracy by submitting, or allowing others to submit, a written notice with the Texas State Board of Physician Assistant Examiners that fraudulently claimed that R.J.P. would supervise his attempts to provide health care benefits, items and services at La Hacienda Family Clinic. Thereafter, Puig operated La Hacienda Family Clinic without supervision from R.J.P. or any other licensed physician and then submitted claims, or aided and abetted others in the submission of claims, to Medicaid under the Medicaid provider number of R.J.P. for health care benefits, services or items which were not provided by R.J.P.; were not authorized, ordered or supervised R.J.P.; were not provided by a licensed person; or were not provided at all.

Puig admitted that for the period of time beginning on or about May 1, 2005, through on or about Jan. 10, 2006, he provided medical care and services for Medicaid beneficiaries without the authority or the supervision of R.J.P., signed an affidavit sent to the Texas Medical Board in January 2006 - falsely claiming he had been assisting R.J.P., that there had been communications between them and that he believed R.J.P was mentally capable of practicing medicine.

Puig admitted that he submitted or caused to be submitted over 6,000 claims to Medicaid fraudulently using the Texas Medical provider number for R.J.P. for which Medicaid paid the approximately $173,830.56 between May 2005 and January 2006.

The clinic operated by Puig is no longer in operation. Puig remains free on bond of $174,000 pending sentencing scheduled for October 26, 2010.

Puig’s wife, Romelia Sanchez Puig, 41, who allegedly acted as the biller for the clinic she and her husband operated and is also charged for her alleged involvement in the health care fraud scheme, remains on bond pending trial on the charges pending against her.

The investigation leading to the charges in this case was conducted by the FBI and the Texas Attorney General's Medicaid Fraud Control Unit. Assistant United States Attorney Casey N. MacDonald and Special Assistant United States Attorney Rex G. Beasley are prosecuting the case.