Danville Doctor Pleads Guilty to Healthcare Fraud, Tax Evasion Charges
Edwin L. Fuentes, 55, of Danville, Va., waived his right to be indicted and pled guilty today to an Information charging him with one count of healthcare fraud and one count of willfully evading taxes.
According to evidence presented at today’s guilty plea hearing by Assistant United States Attorney Heather L. Carlton, had this case gone to trial the United States would have proven that Fuentes owned and operated a general medical practice in Danville called Morning Star Family Medicine.
From at least January 2012 through December 2014, Morning Star billed covered patient visits to various insurers, such as Optima, Virginia Premier, Aetna, Anthem, Medicare and Medicaid. Fuentes directed and ordered all billing decisions at Morning Star and was the only one authorized to complete the superbill, which is the form that determines which services to invoice to a health care benefit program for a patient’s medical visits.
Fuentes directed and ordered Morning Star employees, from at least January 2012 through December 2014, to bill various health care benefit programs for services he did not provide through a scheme to defraud those programs. Specifically, Fuentes would bill health care benefit programs for the patient visit under an “evaluation and management” code. In addition, Fuentes would bill the health care benefit program for “preventative counseling” sessions for the exact same patients visits, which would result, effectively, in double billing. After auditors discovered this fraud in 2012, 2013 and again in 2014, Fuentes attempted to conceal the fraud by making notes in patient records that some sort of counseling had been administered to patients. However, patients never received counseling.
During this time period, various health care benefit programs overpaid Fuentes, through Morning Star, $998,228. In addition, Fuentes diverted some of these funds to a Wells Fargo bank account. He used these funds for day trading, the profits of which he concealed from the Internal Revenue Service by not reporting it as income for the tax years of 2011 through 2014.
The investigation of the case was conducted by the Virginia Office of the Attorney General- Medicaid Fraud Control Unit, U.S. Department of Health and Human Services Office of the Inspector General and the Internal Revenue Service - Criminal Investigations. The Danville Police Department and the Virginia Department of Motor Vehicles- Law Enforcement Division provided assistance to the investigation. Assistant United States Attorney Heather L. Carlton and Special Assistant United States Attorney Kari Munro prosecuted the case for the United States.