SACRAMENTO, Calif. — Gabriella Santibanez, 58, and her sister Lisa Hazard, 54, both of Temecula, California, pleaded guilty Friday to conspiring to commit over $7 million in health care fraud, U.S. Attorney Phillip A. Talbert announced.
According to court documents, between Dec, 1, 2015, and Dec, 1, 2020, Santibanez and Hazard ran a mobile phlebotomy company, PhlebXpress Inc. that provided phlebotomy and other medical collection services at patients’ homes and long-term care facilities in Sacramento and elsewhere. Santibanez and Hazard agreed to bill Medicare for services provided that were not reimbursable by Medicare. Santibanez and Hazard also agreed to bill Medicare for overstated mileage that PhlebXpress phlebotomists traveled. On average, Santibanez and Hazard caused false billing to Medicare of over 140 miles for each patient seen by PhlebXpress. Santibanez and Hazard caused a loss to Medicare of at least $7.5 million based on false billing by PhlebXpress.
In November 2020, due to “credible allegations of fraud” at PhlebXpress, Medicare instituted a payment suspension for PhlebXpress under which Medicare ceased paying PhlebXpress for the services it continued to bill Medicare.
According to court documents, between July 1, 2021, and Dec. 31, 2021, Santibanez and Hazard agreed to circumvent the payment suspension by representing to Medicare that services provided to Medicare patients were done by another company, Phlebotomy Solutions, when they were in fact being provided by PhlebXpress through its contractors and employees from PhlebXpress’s offices. Through Phlebotomy Solutions, Santibanez and Hazard agreed to bill Medicare for a non-reimbursable service, misrepresenting that it was for another reimbursable service and overstating the mileage traveled by phlebotomists in order to receive additional money from Medicare. For example, in September 2021, Phlebotomy Solutions billed Medicare for 124.6 miles of travel by a phlebotomist when in fact the phlebotomist travelled 1.4 miles. Santibanez and Hazard caused a loss to Medicare of at least $50,000 based on false billing by Phlebotomy Solutions.
This case is the product of an investigation by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorney Lee Bickley is prosecuting the case.
Santibanez and Hazard are scheduled to be sentenced by U.S. District Judge William B. Shubb on May 1, 2023. They each face a maximum penalty of 10 years in prison and $250,000 fine. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.