Owner, COO of San Antonio and Laredo Clinics Sentenced in Healthcare Fraud Case

The owner and COO of emergency care clinics here and in Laredo, both residents of San Antonio, have been convicted of their role in more than $ 500,000 in fraudulent billings to public insurance companies and private.

Christopher Felix Montoya, 47, was sentenced Monday by a federal judge to serve two consecutive 18-month prison terms, while Nancy Almaguer was sentenced to 18 months in prison.

Montoya, who was the owner and operator of the TPC family medicine and emergency care clinics, and Almaguer, who was the company’s chief operating officer, pleaded guilty to one count of conspiracy aimed at defrauding the United States and paying and receiving kickbacks on healthcare.

From September 2018 to June 2019, Montoya and Almaguer agreed to refer requests for lab tests, such as nasal swabs, to specific labs, according to court documents. The labs billed for insurance programs, including Medicare and TRICARE, and paid Almaguer and Montoya a percentage of their receipts in exchange for referrals through a third party, officials said.

TRICARE is a federal insurance program for current and retired military personnel and their families.

In another case, Montoya pleaded guilty in July to one count of conspiracy to receive healthcare bribes. Montoya said he received bribes to write compound drug prescriptions from a California pharmacy that had high reimbursements from TRICARE. The bribes took place over five months, starting in February 2015.

TRICARE was billed around $ 8.8 million for prescriptions written by Montoya, for which TRICARE paid nearly $ 6.7 million, officials said.

In addition to a jail term, Almaguer was ordered to confiscate $ 137,792.10 in proceeds of crime and pay $ 52,603.62 in restitution.

Montoya, who was a licensed medical assistant, was ordered to pay $ 849,865.93 in restitution. His license was suspended in June when a disciplinary committee of the Texas Physician Assistant Board discovered that Montoya was still running his practice from prison.

He also continued to bill Medicare for services rendered despite being away from his clinics to treat patients, according to the Texas Medical Board. His license remains suspended on Tuesday, according to the council’s website.

“Bribe regulations exist to protect patient choice and ensure that only medically necessary procedures are performed,” US lawyer Ashley Hoff said in a press release. “Our office continues to help protect federal insurance programs against fraud. We hope that these sentences indicate that these regulations must be taken seriously. “

The FBI, the Medicaid Fraud Control Unit of the Texas Attorney General’s Office, the Inspector General of the US Department of Health and Human Services; the Inspector General of the United States Office of Professional Management; and the Defense Criminal Investigation Service investigated the case.

“Healthcare fraud is seriously damaging the US economy by costing this country billions of dollars a year,” said Christopher Combs, special agent in charge of the San Antonio division of the FBI. “These losses mean increased medical costs for all Americans. The FBI is committed to investigating those involved in this crime through investigative partnerships with other federal agencies.

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