Wednesday, August 4, 2010

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In Case You Missed It: Texas Attorney General Investigation Leads to Health Care Fraud Conviction

The following news release was issued by the United States Attorney's Office for the Southern District of Texas on Aug. 3, 2010:

Wife of Physician's Assistant Pleads Guilty to Conspiring to Defraud Medicaid

(McALLEN, Texas) – Romelia Sanchez Puig, 42, of Edinburg, Texas, and wife of Manuel Anthony Puig, a local physician assistant, has pleaded guilty to conspiracy to defraud Medicare and the Texas Medicaid program, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today.

Romelia Puig was originally indicted along with her husband, Manuel Anthony Puig, 44, also of Edinburg, on March 9, 2010, on charges of health care fraud, mail fraud and conspiracy to commit health care fraud arising from their operation of the La Hacienda Family Clinic near Alton, Texas. On July 27, 2010, a superseding indictment was returned against Romelia Puig charging her with an additional four counts of mail fraud arising from the operation of La Hacienda Clinic and the Mission Clinic in Mission, Texas. The superseding indictment also added two additional defendants and identified the Medicare program as a victim of the alleged fraud scheme. Manuel Anthony Puig was not charged in the superseding indictment because he pleaded guilty before Chief United States District Judge Ricardo H. Hinojosa on Friday July 23, 2010, to the conspiracy charge of the original indictment. He faces up to 10 years in prison and a $250,000 fine for the conviction and remains free on bond of $174,000 pending sentencing scheduled for Oct. 26, 2010.

On Monday, Aug. 2, 2010, Romelia Puig pleaded guilty before Chief United States District Judge Ricardo H. Hinojosa to the conspiracy charge in the superseding indictment. She faces up to 10 years in prison and a $250,000 fine for the conviction.

Manuel Puig is a physician assistant. By state law, a licensed physician is required to supervise and delegate work to a physician assistant and to be responsible for the physician assistant. At yesterday’s hearing, Romelia Puig admitted that in 2005, she joined an ongoing conspiracy with others to submit claims to the health care benefit programs known as Medicare and the Texas Medicaid program 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 or 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 Mr. Puig’s attempts to provide health care benefits, items or services.

Romelia Puig admitted that she 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 R.J.P. would supervise Manuel Puig’s attempts to provide health care benefits, items and services at La Hacienda Family Clinic. Thereafter, Mr. Puig operated La Hacienda Family Clinic without supervision from R.J.P. or any other licensed physician and Romelia Puig 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.

Romelia Puig also admitted that between May 2005 and January 2006, she was the biller at La Hacienda Family Clinic and she submitted or caused to be submitted more than 6,000 claims to Medicare and Medicaid fraudulently using the Texas Medical provider number for R.J.P. for which Medicare and Medicaid paid approximately $173,830.56.

La Hacienda Family Clinic is no longer in operation. Romelia Puig remains free on bond of $174,000 pending sentencing scheduled for Nov. 8, 2010.

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