Palmview, Texas, Siblings Convicted of Health Care Fraud Conspiracy
|Dec. 7, 2011|
McALLEN, Texas – A co-owner and manager of a McAllen-area durable medical equipment (DME) business have both pleaded guilty to conspiracy to commit health care fraud for their roles in a scheme to defraud Medicare and Medicaid through fraudulent billings for power wheelchairs, United States Attorney Kenneth Magidson announced today.
Velma Alaniz, an owner of Ace Medical Equipment and Supplies, and Valente Alaniz, Ace Medical’s manager, both of Palmview, Texas, pleaded guilty to one count of conspiracy to commit health care fraud at a hearing before U.S. District Judge Randy Crane this afternoon.
At today’s hearing, Velma Alaniz and her brother Valente admitted to conspiring to submit false and fraudulent claims to the Medicare and Medicaid programs related to Ace Medical’s purported sale of power wheelchairs to Medicare and Medicaid patients. In each claim for a power wheelchair, the defendants represented to Medicare and Medicaid that the item was prescribed by the patient’s physician and had been delivered to the patient when, in fact, the defendants knew that both of these representations were false with respect to numerous claims. In other instances, the defendants would submit false claims to Medicare and Medicaid by representing that power wheelchairs had been delivered to patients when, instead, they would deliver less expensive mobility scooters to the patients.
The defendants also admitted at today’s hearing that, in an attempt to conceal the fraud, they falsified and forged physicians’ medical orders and examination reports, as well as a variety of other Medicare and Medicaid-related documents that were kept in Ace Medical’s patients’ files. For example, in May 2010, investigators served a request on Ace Medical for files pertaining to a number of Medicare and Medicaid patients who purportedly received power wheelchairs from Ace Medical. Knowing that fraudulent claims had been submitted for these patients, Velma Alaniz instructed Valente Alaniz to “fix” the patients’ files to make the fraudulent power wheelchair claims appear to be mere billing errors. To that end, Valente Alaniz filled out a Medicare Overpayment Refund Form for each patient whose Medicare account was fraudulently billed for a power wheelchair and then placed the refund form in the patient’s file prior to producing the file to investigators. On each form, Valente included a fictitious date of reimbursement that Ace Medical purportedly made to Medicare; the fictitious date of reimbursement used by Valente was typically a few days after the particular false power wheelchair claim was submitted. Each refund form also stated that the power wheelchair claim was “billed in error.” Further investigation revealed that the defendants never sent the refund forms to Medicare nor intended to make any reimbursements and that the defendants planted the falsified and backdated refund forms in the patient files in an effort to conceal the fraud from investigators.
Judge Crane has set sentencing for Feb. 15, 2012, at 2:00 p.m. at which time each defendant will face a maximum of 10 years in federal prison without parole and up to a $250,000 fine.
The investigation leading to the charges was conducted by the U.S. Department of Health and Human Services—Office of Inspector General, the U.S. Secret Service and the Texas Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorney Greg Saikin is prosecuting the case.