Health Care Fraud comes in many forms! Folks in the health care field find creative ways to enrich themselves at the cost of funding sources for health care services – for the elderly in the US that is generally Medicare. But from time to time it’s interesting to see the creativity that people will use to defraud the system.
Dr. Educardo Carrillo, 42, a McAllen area doctor has been convicted of health care fraud and aggravated identity theft. He recently entered his guilty plea before U.S. District Judge Randy Crane. Also convicted was his assistant – Martha Uribe Medrano, 48, of Edinburg.
Dr. Carrillo admitted he attempted to cause others to bill Medicare for patients who were deceased on the dates that Carrillo claimed to have provided services to the patients. Carrillo submitted fraudulent documentation to a billing company so that the company would file claims with Medicare for reimbursement of physician services. Records obtained by law enforcement show that the patients were deceased on the dates that Carrillo alleged to have provided services to the patients.
What was he thinking?
OK…I get it at least the dead folks can’t complain or raise a stink about his unethical practices, but really – did he think he’d get by with such an audacious plan?
But more than that, Dr. Carrillo also admitted to engaging in a scheme with his co-conspirator and assistant, Medrano, to solicit and obtain illegal kickbacks in exchange for patient referrals. Carrillo and Medrano solicited and obtained cash in exchange for referrals of Medicare beneficiaries. Carrillo admitted he used the Medicare number and personal information of a patient in the illegal kickback exchange. Medrano pleaded guilty to illegal remunerations for her role in the scheme.
Sentencing for both Carrillo and Medrano has been set for Feb. 3, 2016, at 2:00 p.m. At that time, Carrillo faces a maximum of 10 years in federal prison and a possible $250,000 fine. He also faces a mandatory two-year additional prison term which must be served consecutively to any other sentence imposed. For her conviction, Medrano faces a maximum of five years and a $25,000 possible fine.
Prison will be the final outcome and Dr. Carrillo – well most likely – former Dr. Carrillo won’t be practicing medicine for a long time if ever.
A final question
Looking back I’d love to ask Dr. Carrillo – was it worth it? My guess is he’s easily say “No!”
I am so angry over this greed that I don’t believe that what I would have to say would be appropriate for the world to see