Houston Medical Clinic Owner Convicted in $11 Million Medicare Fraud Scheme
The owner and operator of a purported medical clinic, QC Medical Clinic, was convicted on Jan. 24, by a federal jury of participating in an $11 million Medicare fraud scheme in which fraudulent medical documents were sold to home-health agencies in and around Houston.
The conviction was announced by Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan Patrick of the Southern District of Texas and Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office.
Brenda Rodriguez, 57, of Harris County, Texas, was convicted of one count of conspiracy to commit healthcare fraud and three counts of healthcare fraud following a jury trial before U.S. District Judge Lynn Hughes of the Southern District of Texas. Rodriguez is expected to be sentenced on April 29.
According to the evidence presented at trial, from October 2012 through August 2015, Rodriguez and others conspired to defraud Medicare by selling Plans of Care, and other medical documents signed by a doctor, through QC Medical Clinic (“QC Medical”) to various home-health services, resulting in approximately $11 million in false and fraudulent claims for home-health services billed to Medicare.
The evidence at trial showed that home-health agencies billed Medicare for home health services that were not medically necessary and in many instances, not provided.
To date, three others have pleaded guilty or were convicted based on their roles in a larger fraudulent scheme that included QC Medical. John Ramirez, M.D., was convicted of conspiracy to commit healthcare fraud and healthcare fraud for his role at a related purported clinic and is awaiting sentencing before U.S. District Judge David Hittner of the Southern District of Texas. Nenna Iro and Magdalene Akharamen, owners of Houston area home-health agencies, each pleaded guilty to conspiracy to commit healthcare fraud in purchasing Plans of Care and other signed medical documents from QC Medical.
The case was investigated by the FBI, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas. The case is being prosecuted by Trial Attorney Scott Armstrong of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Tina Ansari and Thomas Heyward Carter.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and the U.S. Department of Health and Human Services (HHS) to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.