Tuesday, April 1, 2014
The U.S. Attorney for the Northern District of Texas issued the following news releas on March 31, 2014:
Father and Son Sentenced to Lengthy Federal Prison Sentences on Conspiracy and Health Care Fraud Convictions
Defendants Owned a Physician House Call Company and Billed for Services Not Rendered
DALLAS — Two Grand Prairie men convicted at trial in October 2013 on conspiracy and health care fraud charges related to their operation of A Medical House Calls, a physician house-call company in North Texas, were sentenced this morning by U.S. District Judge David C. Godbey, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Lawrence Dale St. John, 67, was sentenced to serve a total of 262 months in federal prison, and his son, Jeffrey Dale St. John, 42, was sentenced to serve a total of 135 months in federal prison. Both St. John’s were ordered to pay restitution to the Centers for Medicare and Medicaid Services (CMS).
Each defendant was convicted at trial on one count of conspiracy to commit health care fraud and 13 substantive counts of health care fraud. Co-defendant Dr. Nicolas Alfonso Padron, 54, of Garland pleaded guilty in September 2013 to one count of conspiracy to commit health care fraud. Dr. Padron, who joined A Medical as its medical director in December 2009, testified, as did a number of nurse practitioners, physician assistants and company staff, services billed were never performed. Earlier this month, Judge Godbey sentenced Dr. Padron to 57 months in federal prison and ordered that he also pay restitution to CMS.
A Medical provided physician visits to Medicare beneficiaries in their homes rather than at a doctor’s office. A Medical, aka A+ Medical House Calls and ANM Physician House Calls, was owned by Lawrence St. John; Jeffrey St. John ran its daily operations. A Medical had locations in Mesquite, Texas; Dallas; and Carrollton, Texas. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient.
Once A Medical established a Medicare beneficiary for physician home-visit services, it would submit billing for fraudulent care plan oversight claims. The company did not provide primary care physician services to Medicare beneficiaries.
According to documents filed in the case and evidence presented at trial, from May 2010 to January 2012, the defendants conspired together and with others to defraud the Medicare program. A Medical, at the direction of Lawrence and Jeffrey St. John, submitted claims to Medicare using Dr. Padron’s unique Medicare number, with Dr. Padron’s permission, regardless of the claim’s merit.
The defendants conspired together to bill Medicare for care plan oversight by Dr. Padron for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise.
In total, the defendants billed taxpayers for $1.4 million of services that were either not medically necessary or not rendered at all. Through the fraudulent certifications, Medicare was billed an additional $9.7 million by home health agencies.
The U.S. Department of Health and Human Services' Office of Inspector General, the FBI and the Texas Attorney General's Medicaid Fraud Control Unit investigated. Assistant U.S. Attorneys Kate Pfeifle and J. Nicholas Bunch prosecuted.