The very decision to commence with a scheme that seeks to defraud medical insurance programs is an incredibly bold one. And although that can be seen as an understatement, it needs to be stated. Where does one get the audacity? When you consider the very reason that such insurance programs exist – to provide funding to those in need of often life-saving medical care – it’s truly shameful to try and rip them off.
This is especially true when your attempts to defraud medical insurance programs have been noticed and warned against continuing. Bold doesn’t even begin to explain the actions of Danville, Virginia doctor, Edwin L. Fuentes. The 55 year-old billed numerous insurers for services he never administered – even after he was warned about doing so. As reported by Elizabeth Tyree of WSET two days ago, Fuentes now faces two years in prison for his criminal actions.
According to Tyree’s report, Fuentes has pleaded guilty to one count of healthcare fraud and one count of willfully evading taxes. In addition to his two-year prison sentence, he has been ordered to pay restitution in the amount of $1,739,194 in addition to repaying $125,789 in investigative costs.
How did Fuentes pull off his healthcare fraud scheme?
As the owner and operator of Danville’s Morning Star Family Medicine, Fuentes knowingly and wilfully executed a scheme that involved double-billing the same patient visits under two different billing codes. He then attempted to conceal his fraudulent actions by creating falsified notes and putting them in patient records. Among the benefit programs Fuentes defrauded were Optima, Virginia Premier, Aetna, Anthem, Medicare and Medicaid.
According to evidence, this scheme took place between January 2012 and December 2014. In total, Fuentes was overpaid more than $900,000 by the healthcare programs. And, as you may have guessed from his guilty plea, he failed to report this income on his tax returns.
There have been many choice words for Fuentes.
Kimberly A. Lappin is a Special Agent in Charge of the IRS-Criminal Investigation, Washington D.C. Field Office. “Mr. Fuentes chose to use the government healthcare programs as a personal piggy bank and today he is being held accountable,” she is quoted as saying in a report published by the Western District of Virginia branch of the United States Department of Justice, “Mr. Fuentes’ sentence serves as a reminder that IRS Criminal Investigation is committed to maintaining the integrity of our tax system and will continuously direct its efforts to those who willfully choose to evade their tax obligations.”
Special Agent in Charge Nick DiGiulio of the United States Department of Health and Human Services, Office of the Inspector General had this to say: “Doctors who overcharge insurance plans for their services, place false notes in patient files, then hide the stolen money will be held responsible for their crimes. We will continue to work with our law enforcement partners to bring justice to those who steal our health care dollars.”
Could you use some expert assistance with an upcoming healthcare fraud case?
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