Health Care Fraud: Dr. Pedro Garcia Charged For His Scheme to Defraud Medicare

Health Care Fraud
Scheme to Defraud Medicare

RGV Area Doctor Charged in Health Care Fraud and Illegal Kickback Scheme

McALLEN, Texas ‐ A Rio Grande Valley area doctor has been charged in a federal indictment for his scheme to defraud Medicare and to solicit and obtain illegal kickbacks in exchange for patient referrals, announced U.S. Attorney Kenneth Magidson.

A federal grand jury in McAllen returned the indictment under seal Aug. 30, 2016. It was unsealed today upon the arrest of Dr. Pedro Garcia, 68, of Mission. He is expected to make his initial appearance before U.S. Magistrate Judge Peter Ormsby tomorrow at 10:30 a.m.

According to the charges, Garcia solicited and obtained cash in exchange for referrals of Medicare beneficiaries to prospective home health agencies. Garcia allegedly signed patient forms for patients he did not treat or provide services to and conveyed the forms to home health agencies, claiming he had treated or provided services to the patients. Some of the patients were deceased on the dates Garcia claims to have provided treatment or services, according to the indictment.

The indictment also alleges that from 2014 to 2016, Garcia submitted or caused others to submit claims to Medicare for reimbursement of home health services that were not provided. Garcia allegedly filed or caused others to file claims with Medicare knowing that the claims were false since the services were not provided. According to the indictment, Garcia illegally used the beneficiaries identifying information to perpetrate the fraud.

Garcia is charged with one count of conspiracy to commit health care fraud, four counts of health care fraud, four counts of aggravated identity theft, three counts of illegal remunerations and one count of obstruction of criminal investigations of health care offenses.

Conspiracy to commit health care fraud and each of the four counts of health care fraud carry a maximum punishment of 10 years in federal prison and a $250,000 fine, upon conviction. Illegal remunerations and obstruction of criminal investigations of health care offenses carry a maximum punishment of five years in federal prison and a $25,000 fine. For the aggravated identity theft, Garcia also faces a mandatory two‐year additional prison term which must be served consecutively to any other prison sentence imposed.

The FBI, Department of Health and Human Services‐Office of Inspector General, Texas Attorney General’s Medicaid Fraud Control Unit and the Texas Health and Human Services Commission-Office of the Inspector General conducted the investigation. Assistant U.S. Attorneys Michael Day and Andrew Swartz are prosecuting the case.

An indictment is an accusation of criminal conduct, not evidence.

A defendant is presumed innocent unless convicted through due process of law.


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