Friday, October 18, 2013

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Former Co-Owner of RGV DME Biller Sentenced to Federal Prison for Health Care Fraud Scheme

McALLEN - The co-owner of a now defunct McAllen area durable medical equipment (DME) business and a former medical biller have been ordered to prison for their roles in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings, United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott announced today.

Former RGV DME Co-Owner Carla Cantu Herrera, 32 along with her ex-husband Marcelo Herrera, 41, and their former employee Ramon De La Garza, 52, all of Mission, pleaded guilty on Feb. 21, 2013, to conspiring to defraud Medicare and Texas Medicaid. Beatriz Ramos, 29, of Edinburg, a former biller for RGV DME, pleaded guilty to the conspiracy on Oct. 16, 2012. Marcelo Herrera and De La Garza also pleaded guilty to one count of aggravated identity theft for unlawfully using the identity of a beneficiary to bill Medicare and Medicaid $5,000 for a power wheelchair that was not requested, prescribed, needed or delivered.

On Thursday, Carla Herrera was handed a sentence of 80 months imprisonment for the conspiracy conviction. She will also serve three years of supervision following her release. In addition to the prison sentence, she was ordered to pay restitution to Medicare and Medicaid in the amount of $5.5 million. As part of her plea of guilty, Carla Herrera agreed to the entry of a money judgment against her of more than $5.5 million and to forfeit the wheelchairs, scooters and other DME items discovered in a leased storage facility in Alamo, which had been rented by Marcelo Herrera and ultimately seized by the FBI.

Ramos was handed a sentence of two years imprisonment and two years of supervised release for the conspiracy conviction. In addition, she will be ordered to pay restitution to Medicare and Medicaid, an action that has been continued until Nov. 14.

Earlier this year the Court sentenced Marcelo Herrera and De La Garza to prison for their roles in the crimes.

Marcelo Herrera was sentenced in July to 120 months for the conspiracy as well as the mandatory 24 months for aggravated identity theft for a total of 144 months in federal prison, followed by three years of supervision after he is released from prison. The court ordered him to pay restitution to Medicare and Medicaid in the amount of $6.1 million and a money judgment was entered against him for that amount. The Court also ordered that he forfeit wheelchairs, scooters and other DME items discovered in his leased storage facility in Alamo.

De La Garza, was sentenced to 110 months for conspiracy to defraud Medicare and Medicaid and an additional mandatory 24-month-term for aggravated identity theft which must be served consecutively to the other sentence imposed, resulting in a total sentence of 134 months in federal prison. In addition to the prison sentence, he was ordered to pay restitution to Medicare and Medicaid in the amount of $5 million, and a money judgment was entered against him for that amount. He will also serve three years of supervision following release from prison.

From early 2004 through late 2011, Marcelo Herrera, who did business as RGV DME in the McAllen area, engaged in and directed a scheme to submit fraudulent claims to Medicare and Texas Medicaid for power wheelchairs, incontinent supplies, hospital beds and mattresses as well as other DME supplies. From January 2006 through February 2010, his ex-wife, Carla Cantu Herrera - who admitted to being marketing director, chief financial officer, chief operating officer, office manager, human resources manager and co-owner of RGV DME - and billers De La Garza and Ramos all participated in the conspiracy and aided Marcello Herrera and each other in the submission of fraudulent billings, wire fraud and theft of the identities of beneficiaries and doctors.

In court on Feb. 21, 2013, Carla Herrera admitted that during her participation in the conspiracy, the false and fraudulent claims to Medicare and Texas Medicaid exceeded $9.9 million for which they received illegal payments exceeding $5.5 million. The Herreras and De La Garza admitted that approximately 85 percent of their Medicare and Texas Medicaid billings were false and fraudulent. The trio also admitted that marketers were used to obtain Medicare and Medicaid identification numbers and other information from beneficiaries which they in turn used to fraudulently bill Medicare and Medicaid for DME that was either never prescribed or prescribed but never delivered.

The Herreras further acknowledged they or their marketers attempted to obtain referrals of patients or orders for DME from doctors in exchange for gifts. The investigation leading to the charges was conducted by the FBI, the U.S. Department of Health and Human Services-Office of Inspector General and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant United States Attorney Rex Beasley and Assistant United States Attorney (AUSA) Grady Leupold prosecuted the case. AUSAs Mary Ellen Smyth and Kristine Rollinson assisted with the asset forfeiture aspects of the case.