Two convicted in multimillion-dollar adult daycare fraud scheme

McALLEN, Texas – A federal jury has returned guilty verdicts against a doctor and a clinic employee for receiving illegal kickbacks after ordering unnecessary lab tests and prescriptions, announced U.S. Attorney Alamdar S. Hamdani.

The jury deliberated for approximately three hours before finding Dr. Osama Nahas, 69, McAllen, and Isabel Pruneda, 53, Edinburg, guilty of conspiracy to commit healthcare fraud, healthcare fraud and conspiracy to violate the Anti-Kickback Statute following a two-week trial. Pruneda was also convicted for aggravated identity theft.

“Adult day cares are supposed to be places where the elderly and vulnerable feel safe, not vehicles for scheming doctors and staff to make illegal profits through kickbacks and get-rich quick opportunities” said Hamdani. “Nahas and Pruneda preyed on the elderly by bribing their way into adult care facilities, abusing the trust and respect that doctors and medical professionals ordinarily deserve. Today’s conviction sends a message that patients should never be seen merely as dollar signs and that kickbacks play no role in the services that doctors order.”

Nahas is the owner and physician at Crosspoint Medical Clinic in Edinburg. He would travel to adult day care centers around the Rio Grande Valley ordering unnecessary lab tests and prescriptions on behalf of elderly and vulnerable clients who were spending time there. Pruneda, a medical assistant at Crosspoint, assisted Nahas in the scheme, helping to forge patient signatures on consent forms and misappropriate expensive patient medications such as pain creams. Among other things, Pruneda would strip patient information off and remove creams from their boxes so that she could hand them out as “goodie bags” to incentivize patients to be tested. 

From January 2016 to December 2017, Nahas and Pruneda ordered unnecessary lab tests and prescriptions which resulting in millions in losses. They directed those prescriptions and tests to companies who then paid them in kickbacks.

In June 2018, law enforcement executed a search warrant at Crosspoint and found hundreds of thousands in stolen medications.

Nahas and Pruneda also bribed their way into the adult daycare facilities by offering kickbacks to the adult daycare owners disguised as “rent” payments. 

The jury heard witness testimony revealing both Nahas and Pruneda accepted bribes in exchange for referrals, many of which were also disguised as “rent” payments.

Evidence revealed that both received tens of thousands of dollars in kickbacks from January 2016 to December 2017.

Nahas attempted to convince the jury the payments he received were legitimate “rent” payments for the use of space, and Pruneda ordered all the prescriptions and lab tests without his consent. Conversely, Pruneda’s defense argued she was doing what Nahas taught her and following orders, and she denied committing any forgeries. The jury did not believe those claims and found both guilty as charged.

U.S. District Chief Judge Randy Crane presided over the trial and set sentencing for May 16. At that time, both face up to 10 years in federal prison for the healthcare fraud conspiracy and each substantive healthcare fraud conviction, while the kickback conspiracy carries another possible five years in prison. For aggravated identity theft, Pruneda must also serve a mandatory two years which must be served consecutively to any other prison term imposed. They could also be ordered to pay up to $250,000 in fines.

Pruneda was taken into custody while Nahas was permitted to remain on bond pending their detention hearings set for March 4 and 8, respectively.

The FBI, Department of Health and Human Services – Office of Inspector General (OIG), Texas Attorney General’s Medicaid Fraud Control Unit and Texas Health and Human Services - OIG conducted the investigation. Assistant U.S. Attorneys Andrew Swartz and Brad Gray are prosecuting the case.