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Feb. 12, 2010

JURY CONVICTS CORPUS CHRISTI COUPLE AND SAN ANTONIO ORTHOTIST OF DEFRRAUDING HEALTH CARE PROGRAMS

(CORPUS CHRISTI, Texas) -  A federal jury has convicted a Corpus Christi couple and an orthotist from San Antonio, Texas of defrauding Medicare and the Texas Medicaid Program, United States Attorney Tim Johnson and Texas Attorney General Greg Abbott announced today.

Jeanette Garcia, 43, the owner of Orthopedic Specialists DME Inc., (OS-DME) formerly located on the 2200 block of Morgan Avenue in Corpus Christi, and her husband Eleazar (Eli) Garcia, 53, both of Corpus Christi, were indicted by a federal grand jury in March 2009. Also indicted were John D. Martinez, 51, and his brother Frank D. Martinez, 47, both licensed orthotists and owners of San Antonio Orthotics & Artificial Limbs (SAO&AL) located on the 7200 block of Louis Pasteur Drive in San Antonio, Texas. All four defendants were charged with conspiracy and a total of 19 counts  of health care fraud for submitting or assisting in the submission of false or fraudulent claims to Medicare, Medicaid and United HealthCare Group for medical services and supplies furnished by Eli Garcia.
   
Today, after a two week trial and approximately six hours of deliberation a federal jury convicted Jeanette Garcia, of one count of conspiring to commit health care fraud against Medicare, Medicaid and United HealthCare Group and thirteen counts of submitting false and fraudulent claims to Medicare, Medicaid and United HealthCare Group; her husband, Eleazar (Eli) Garcia, was convicted of the same conspiracy count and five counts of submitting false and fraudulent claims to Medicare and Medicaid. John D. Martinez was convicted of twelve counts of submitting false and fraudulent claims to Medicare, Medicaid and United HealthCare Group.  Jeannette Garcia, Eli Garcia and John Martinez were acquitted of the remaining charged counts. Frank D. Martinez was acquitted on all counts. 

Through the testimony of investigators from the Medicaid Fraud Control Unit of the Texas Attorney General’s Office, United Healthcare Group; patients and representatives of the Medicare and Medicaid programs, the jury learned that Jeanette Garcia hired her husband, Eli Garcia, to provide orthotic and prosthetic goods and services to diabetic patients and others on behalf of OS-DME. But Eli Garcia has never held a license to practice orthotics in the State of Texas having taken and failed the test six times and been ordered by the Texas Board of Orthotics and Prosthetics to cease and desist practicing orthotics since Oct. 9, 2001. Nonetheless, beginning in February 2002 and continuing until at least Dec. 23, 2008, Jeanette and Eli Garcia, conspired to and did execute a scheme to submit false and fraudulent bills to Medicare and Medicaid for medical services and supplies provided by Eli Garcia. As part of that scheme, the Garcia obtained and maintained reinstatement of the facility accreditation of OS-DME and its Medicare provider number through representations that John Martinez would be the licensed orthotist on-site at OS-DME in Corpus Christi. John Martinez only traveled to Corpus Christi once a week. Eli Garcia continued to supply medical devices including shoes and inserts to diabetic patients and others in Corpus Christi. OS-DME submitted bills to Medicare and Medicaid for the services performed by Eli Garcia then paid John Martinez a percentage of the money obtained from Medicare and Medicaid. 

The jury also heard testimony that from February 2002 through December 2008 Jeanette and Eli Garcia, assisted by John Martinez billed Medicare and the Texas Medicaid program for shoes and inserts that were provided to diabetic patients through OS-DME. The diabetic patients went to OS-DME with prescriptions from their doctors for special shoes and inserts that were supposed to be individually customized for each patient's foot. Instead of providing the customized shoes and inserts needed to protect the patient’s feet from the complications of their disease, Eli Garcia provided the patients with nothing more than off-the-shelf shoes and inserts that could have been found in any shoe store at the mall. Testimony also proved that although Jeanette and Eli Garcia provided absolutely no customized items to the patients, they billed Medicare and the Texas Medicaid program over $530,000 for customized shoes and inserts, and were paid over $294,000. The shoes and inserts did not always fit and at least one patient lost a toe after wearing the shoes provided to him by Eli Garcia. 

The jury also heard that from November 2003 through December 2008 OS-DME had contracts with United HealthGroup to be in United's network of preferred providers and that during that time, OS-DME through Jeanette Garcia billed United over $576,000, and was paid over $324,000 for medical services and items that were claimed to have provided to persons insured by United. The bills were false and fraudulent because the United members were actually treated by SAO&AL which did not have a network provider contract with United.  United would have denied the bills from SAO&AL or paid them at a reduced rate. To get around United’s billing restrictions, SAO&AL sent patient records to Jeanette Garcia to fraudulently bill United. OS-DME and SAO&AL split the money received from the false claims submitted to and paid by United.

Judge Janis Graham Jack, who presided over the trial, has set sentencing for April 26, 2010 at 1:30 pm. The health care fraud convictions as well as the conspiracy counts carry a statutory penalty of not more than 10 years imprisonment and not more than a $250,000 fine. Jeanette Garcia, Eleazar (Eli) Garcia and John D. Martinez remain free on bond pending sentencing. 

This case was prosecuted by Assistant U.S. Attorney Michael Hess and Special Assistant U.S. Attorney Rex G. Beasley.

 

 

 

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