Clinic execs get prison in $500K fraud
The owner and the chief operating officer of urgent care clinics here and in Laredo, both San Antonio residents, have been sentenced for their roles in more than $500,000 of fraudulent billings to public and private insurance companies.
Christopher Felix Montoya, 47, was ordered by a federal judge this week to serve two 18month prison sentences, to run consecutively, while Nancy Almaguer received an 18-month sentence.
Montoya, who was the owner and operator of TPC Family Medicine and Urgent Care Clinics, and Almaguer, who was the company’s chief operating officer, pleaded guilty to one count of conspiracy to defraud the U.S. and to pay and receive health care kickbacks.
From September 2018 through June 2019, Montoya and Almaguer agreed to refer lab testing requests, such as nasal swabs, to specific laboratories, according to court documents. The labs billed insurance programs, including Medicare and TRICARE, and paid Almaguer and Montoya a percentage of their receipts in return for the referrals via a third party, officials said.
TRICARE is a federal insurance program for current and retired military service members and their families.
In a separate case, Montoya pleaded guilty in July to one count of conspiracy to receive health care kickbacks. Montoya said he received kickbacks to write prescriptions for compounded medication from a California-based pharmacy that had high TRICARE reimbursements. The kickbacks occurred over five months, beginning in February 2015.
TRICARE was billed roughly $8.8 million for prescriptions that Montoya wrote, for which
TRICARE paid nearly $6.7 million, officials said.
Almaguer also was ordered to forfeit $137,792.10 in criminal proceeds and to pay $52,603.62 in restitution.
Montoya, who was a licensed physician assistant, was ordered to pay $849,865.93 in restitution. His license was suspended in June when a disciplinary panel of the Texas Physician Assistant Board found that Montoya was still running his practice from jail.
He also continued to bill Medicare for services rendered despite not being present at his clinics to treat patients, according to the Texas Medical Board. His license remains suspended as of Tuesday, according to the board’s website.
“Kickback regulations exist to protect patient choice and ensure that only medically necessary procedures are performed,” U.S. Attorney Ashley Hoff said in a news release. “Our office continues to help protect federal insurance programs from fraud. We hope that these sentences communicate that these regulations should be taken seriously.”
The FBI, Texas Attorney General’s Office Medicaid Fraud Control Unit, U.S. Department of Health and Human Services; the U.S. Office of Professional Management’; and the Defense Criminal Investigation Service investigated the case.
“Health care fraud significantly harms the U.S. economy by costing this country billions of dollars a year,” said Christopher Combs, special agent in charge of the FBI’S San Antonio division. “Those losses result in rising medical costs for all Americans. The FBI is committed to investigating those involved in this crime through investigative partnerships with other federal agencies.”