MCALLEN, Texas (ValleyCentral) — The owner of a Rio Grande Valley home health company has been ordered to prison for conspiracy to commit health care fraud, federal authorities announced.
On April 14, 2016, 44-year-old Miguel Angel Contreras of McAllen, pleaded guilty to submitting false and fraudulent claims to Medicare for reimbursements of home health services that were not provided, that a physician had not authorized and/or were not medically necessary, according to a release from the United States Attorney’s Office.
Contreras was an owner and administrator for Sambritt Home Health LLC, according to the release.
On Thursday, Contreras was ordered to serve a 3.75-year sentence immediately followed by one year of supervised release, records show. He was also ordered to pay $1,037,353.78 in restitution.
In handing down the sentence, Judge Micaela Alvarez noted the lengthy duration of the fraud and the multiple ways in which the fraud was committed.
The false and fraudulent claims Contreras submitted to Medicare totaled $724,056.02, according to the release. As a result of the false and fraudulent claims, Medicare paid approximately $1,037,353.78.
Contreras further admitted he paid illegal kickbacks in exchange for patient information, including patient Medicare numbers which he would then use to submit claims to Medicare in order to receive reimbursements.
He also admitted to forging and/or causing others to forge the signatures of physicians on the referral forms or 485 forms, knowing the physicians did not authorize the need for home health services and/or that the beneficiaries did not need or qualify for home health services. Contreras also directed employees and/or co-conspirators to bill Medicare for home health services with 485 forms that were missing physician signatures, the release stated.
He also admitted to creating “ghost notes” for patient files that were intended and calculated to make the fraudulent claims submitted to Medicare appear legitimate.
Contreras was permitted to remain on bond and voluntarily surrender to a U.S. Bureau of Prisons facility to be determined in the near future.