May 3, 2010
CORPUS CHRISTI COUPLE AND SAN ANTONIO ORTHOTIST SENTENCED FOR HEALTH CARE FRAUD
(CORPUS CHRISTI, Texas) - A Corpus Christi couple and an orthotist from San Antonio, Texas, have been sentenced to lengthy terms in federal prison for defrauding Medicare, Medicaid and United HealthCare Group, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today.
Jeanette Garcia, 43, of Corpus Christi, was sentenced 80 months in prison following her conviction in February 2010 of one count of conspiring with her husband Eleazar (Eli) Castillio Garcia, 53, to commit health care fraud and 13 counts of submitting false and fraudulent claims to Medicare, Medicaid and United HealthCare Group. Eli Garcia was convicted by the same jury of one count of conspiring with his wife to commit health care fraud and five counts of submitting false and fraudulent claims to Medicare and Medicaid and was sentenced to 51months in prison. The Garcia’s, the co-owners of Orthopedic Specialists DME Inc., formerly located on the 2200 block of Morgan Avenue in Corpus Christi, will both serve a three-year-term of supervised release following their completion of their prison terms and are responsible for paying $492,000 in restitution. John D. Martinez, 51, a licensed orthotist and co-owner of San Antonio Orthotics & Artificial Limbs (SAOAL) located on the 7200 block of Louis Pasteur Drive in San Antonio, Texas, was convicted by the same jury in February 2010 of 12 counts of submitting false and fraudulent claims to Medicare, Medicaid and United HealthCare Group. Today, he was sentenced to 35 months in prison and is responsible for paying $201,000 in restitution.
Through the testimony of investigators from the Medicaid Fraud Control Unit of the Texas Attorney General’s Office, United Healthcare Group, patients as well as representatives of the Medicare and Medicaid programs, the jury learned that Jeanette Garcia hired her husband to provide orthotic and prosthetic goods and services to diabetic patients and others on behalf of OSDME. Eli Garcia, however, 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 allegedly provided by Eli Garcia. As part of that scheme, the Garcias obtained and maintained reinstatement of the facility accreditation of OSDME and its Medicare provider number through representations that Martinez would be the licensed orthotist on-site at OSDME in Corpus Christi. Martinez only traveled to Corpus Christi once a week. Although Eli Garcia continued to supply medical devices (including shoes and inserts) to diabetic patients and others in Corpus Christi, he did not tell the patients that he had not provided the necessary customization of the devices to meet the specific needs of the individual patients. Although Eli Garcia supplied no customized items to the patients, OSDME submitted bills to Medicare and Medicaid which claimed the patients had received customized medical devices. OSDME then paid Martinez a percentage of the money obtained from Medicare and Medicaid.
The diabetic patients went to OSDME 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 more than $530,000 for customized shoes and inserts and were paid more than $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, OSDME had contracts with United Health Group to be in United's network of preferred providers and that during that time, OSDME (through Jeanette Garcia) billed United more than $576,000 and was paid more than $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 SAOAL which did not have a network provider contract with United. United would have denied the bills from SAOAL or paid them at a reduced rate. To get around United’s billing restrictions, SAOAL sent patient records to Jeanette Garcia to fraudulently bill United. OSDME and SAOAL split the money received from the false claims submitted to and paid by United.
United States District Court Judge Janis Graham Jack has permitted Martinez and Eli Garcia to remain free on bond pending the issuance of orders to surrender to a Bureau of Prison’s facility to be designated in the near future. Jeanette Garcia, who had also previously been out on bond, was immediately remanded to the custody of the United States Marshals Service.
This case was prosecuted by Assistant U.S. Attorney Michael Hess and Special Assistant U.S. Attorney Rex G. Beasley.
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