Three Handed Sentences in Lengthy Health Care Fraud Conspiracy

MCALLEN, TX—Two former clinic staffers and a physician assistant’s wife have all been ordered to prison for conspiracy to defraud Medicare and the Texas Medicaid program in the operation of the Mission Clinic and La Hacienda Family Clinic, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.

Eliza Lozano Lumbreras, 46, and San Juanita Gallegos Lozano, 57, a couple who operated the Mission Clinic, were in the midst of trial in late 2012 when they opted to enter guilty pleas for their roles in the conspiracy. Manuel Anthony Puig, 48, and Romelia Puig, 45, both of Edinburg, operated La Hacienda Family Clinic near Alton and both previously pleaded guilty in advance of trial.

Today, Chief U.S. District Judge Ricardo H. Hinojosa sentenced Lumbreras and Lozano to 50 and 33 months in federal prison, respectively. In addition to the prison terms, Judge Hinojosa ordered they pay $371,720.16 in restitution to Medicare and Medicaid for the false and fraudulent claims they submitted or caused to be submitted to the health care programs. Romelia Puig was ordered to pay $185,881.75 in restitution and received a sentence of 18 months. All will also serve three-year terms of supervised release upon completion of their prison sentences. Manuel Puig will be sentenced Tuesday, November 12, 2013, at 2:30 p.m.

Lumbreras and Lozano conspired together and with the others to submit claims to Medicare and Medicaid using the Medicaid provider number of a medical doctor who, for years before his death, was unable to practice medicine. In fact, the doctor suffered from Parkinson’s disease and associated dementia and had been mentally incompetent to practice medicine since September 2001. Although the doctor was unable to practice, they kept the Mission Clinic open for patient care. Lumbreras and Lozano took the doctor to the Mission Clinic and placed him in an office while Lumbreras saw and treated patients. Neither Lumbreras nor Lozano was licensed to provide any medical services. The government’s evidence showed that between September 2001 and January 2006, Lumbreras and Lozano submitted bills to the Medicare and Medicaid programs which fraudulently claimed the doctor had provided patients with more than 13,000 medical benefits, item,s or services when in fact those services had been provided by Lumbreras or not at all. As a result, Medicare and Medicaid paid more than $344,000 on those claims.

Beginning in April 2005, Lumbreras and Lozano also arranged for Manual Puig to operate La Hacienda Family Clinic in Alton and to send bills to Medicare and Medicaid using the provider number of that same unpracticing doctor. Manuel Puig is physician assistant. By state law, a licensed physician is required to supervise and delegate work to a physician assistant and to be responsible for the physician assistant. At his plea hearing, Manuel Puig admitted he joined the ongoing conspiracy, admitting to fraudulently using the Medicaid provider number of that doctor who was unable to practice medicine nor provide any health care benefits, items, or services; who did not delegate authority to Manuel Puig to provide any health care benefits, items, or services; and who did not supervise Puig’s attempts to provide health care benefits, items, or services.

Romelia Puig admitted that between May 2005 and January 2006, she was the biller at La Hacienda Family Clinic and that she submitted or caused to be submitted more than 6,000 claims to Medicare and Medicaid fraudulently using that Texas Medical provider number for which Medicare and Medicaid paid approximately $173,830.56.

Lumbreras had access to the doctor’s bank accounts and was able to obtain control over the money Medicare and Medicaid paid for the fraudulent bills submitted from the Mission and La Hacienda clinics, which was divided among Lumbreras, Lozano, their families, Puig, and his wife.

Previously released on bond, all were allowed to remain on bond and voluntarily surrender to a U.S. Bureau of Prisons facility to be determined in the near future.

The investigation leading to the charges in this case was conducted by the FBI and the Texas Attorney General’s Medicaid Fraud Control Unit, with assistance from the Mission Police Department. Assistant United States Attorney Casey N. MacDonald and Special Assistant United States Attorney Rex G. Beasley are prosecuting the case.