RGC man pleads guilty in healthcare fraud case, agrees to pay restitution

McALLEN — A Rio Grande City man avoided a federal jury trial after he pleaded guilty last week and agreed to pay more than $385,000 in restitution for healthcare fraud, records show.

Omar Cuate Canales pleaded guilty Tuesday to one count of conspiracy to defraud the United States, and agreed to pay back $385,574.52 in restitution as part of a plea agreement with government prosecutors.

In exchange, the government agreed to dismiss the remaining counts against Canales, specifically eight counts of providing a false statement relating to healthcare matters and five counts of fraud with identification documents, records show.

Canales was indicted last December on 14 counts of fraud in connection with his business, Bluebonnet DME, a Roma-based durable medical equipment business.

Between January 2010 and around October 2016, Canales allegedly billed Texas Medicaid more than $1 million for claims that were supported by either false documentation that he created or documentation that did not exist in Bluebonnet DME.

The 48-year-old man, owner and operator of Bluebonnet DME, “deliberately destroyed patient records to conceal his false claims to Medicaid,” the government alleged.

The indictment, returned by a federal grand jury Dec. 18, alleged Canales committed “one count of conspiracy to submit false statements relating to health care matters, eight counts of false statements relating to health care matters and five counts of aggravated identity theft of local physicians’ names, medical license numbers and national provider identifier numbers.”

According to the Southern District of Texas U.S. Attorney’s Office, each of the counts of false statements related to health care matters carries a maximum punishment of five years in federal prison and a $250,000 possible fine, upon conviction. If convicted of aggravated identity theft, Canales could also face an additional and mandatory two years in federal prison, which must be served consecutively to any other prison sentence imposed.

Canales, who has been free on a $75,000 bond since Dec. 21, 2018, is scheduled in court for sentencing Jan. 15, 2020, records show.

Multiple agencies worked together on the investigation into Canales’ alleged fraud, including the Texas Attorney General’s Medicaid Fraud Control Unit, the FBI and the Department of Health and Human Services – Office of Inspector General.