Texas Border Business
McALLEN, Texas ‐ An owner of a Rio Grande Valley area home health company has been ordered to prison for his conviction of conspiracy to commit health care fraud, announced U.S. Attorney Alamdar S. Hamdani.
Miguel Angel Contreras, 44, McAllen, pleaded guilty April 14, 2016.
U.S. District Judge Micaela Alvarez ordered Contreras to serve a 45-month sentence to be immediately followed by one year of supervised release. Contreras was also ordered to pay $1,037,353.78 in restitution. In handing down the sentence, Judge Alvarez noted the lengthy duration of the fraud and the multiple ways in which the fraud was committed.
Contreras was an owner and administrator for Sambritt Home Health LLC. As part of his plea, he admitted he submitted false and fraudulent claims to Medicare for reimbursement of home health services that were not provided, that a physician had not authorized and/or were not medically necessary.
The false and fraudulent claims Contreras submitted to Medicare totaled $724,056.02. 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. He and/or his co-conspirators would then use the fraudulently obtained Medicare numbers to submit claims to Medicare in order to receive reimbursements.
As part of his plea, Contreras admitted he forged and/or caused 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 directed employees to create “ghost notes” for patient files which were intended and calculated to make the fraudulent claims submitted to Medicare appear legitimate. Contreras also admitted he directed employees and/or co-conspirators to bill Medicare for home health services with 485 forms which were missing physician signatures.
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.
The Department of Health and Human Services‐Office of Inspector General, the FBI, and the Texas Health and Human Services Commission-Office of Inspector General conducted the investigation. Assistant U.S. Attorney Michael Day is prosecuting the case.
