Wife of clinic owner pleads guilty in health care fraud case
McALLEN — A certified nursing assistant who used an ailing 71-year-old doctor’s name to bill nearly $174,000 to Medicaid and Medicare pleaded guilty Monday to one count of conspiracy.
Romelia Sanchez Puig, 42, of Edinburg, told a federal judge she submitted more than 6,000 vouchers without the doctor’s knowledge, seeking reimbursement from the federally funded health care programs for patients seen at an Alton medical office run by her husband.
Manuel Anthony Puig, a 44-year-old physician assistant, initially opened his La Hacienda Family Clinic in 2005, telling state licensors he would be working under the supervision of the Mission doctor even though the man had been declared unfit to practice medicine more than four years prior and had no knowledge of the Puigs’ business.
Medicaid and Medicare rules require that the billing doctor be on site for all procedures billed to the government.
Manuel Puig pleaded guilty July 23 to one conspiracy count, but the resolution of his wife’s case this week resolves only half of the health care fraud case involving the Mission doctor, who is not named in court documents.
Last week, a federal grand jury indicted two of the physician’s former office workers on 13 counts including conspiracy and health care and mail frauds, alleging they kept his Mission practice open and continued seeing patients for more than four years after a diagnosis of Parkinson’s disease forced him to retire.
Eliza Lozano Lumbreras and San Juanita Gallegos Lozano, neither of whom has a medical degree, brought the doctor to his Mission office nearly every day, sat him at a desk, and continued to carry out medical procedures, even though their former employer was nearly incapable of speaking and didn’t even recognize his own family members, prosecutors said. The women billed Medicaid and Medicare for nearly $270,000 in reimbursements from September 2001 to January 2006, the indictment states.
Both women have entered “not guilty” pleas and are set to take their cases before a jury in September.
If convicted on all counts, they could each face up to 20 years in prison.
The Puigs, who are scheduled for sentencing in October, each face a maximum punishment of 10 years in prison.
La Hacienda clinic and the Mission doctor’s office have since shut down. The physician died in 2007.
Medicare is a federally funded program offering health care assistance for individuals who are 65 and older and for the disabled. Medicaid is a federal-state program that helps pay for health care for the needy, aged, blind and disabled and for low-income families with children.
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Jeremy Roebuck covers courts and general assignments for The Monitor. You can reach him at (956) 587-9377.
