SAN ANTONIO, Texas — A former Hidalgo County (Texas) commissioner and his wife were found guilty of fraudulently billing Medicaid and Medicare more than $14 million to take patients on ambulances to dialysis appointments, federal prosecutors said Monday.
Guadalupe Garces Jr. and Araceli Garces each face up to 10 years in prison and a $250,000 fine for conspiracy to commit health care fraud and multiple other counts at their July 18 sentencing. A federal jury in McAllen found the couple guilty late Friday.
Each remains free on $100,000 bond.
The couple, who owned A-Stat Ambulance Inc., first were indicted in December 2006. Federal investigators said they billed Medicare and Medicaid for approximately $12 million and were paid approximately $4.5 million for unnecessary ambulance trips between May 2001 and June 2004.
Court papers show they billed the federal insurance programs between $365 and $570 per day several times a week for the trips.
Guidelines state that ambulances should be used for kidney failure patients who are bedridden and have had a doctor certify the trips as medically necessary. Patients in wheelchairs are supposed to be transported in vans or by other means.
The Garces couple told paramedics not to note that patients were able to walk or sit in wheelchairs and changed ambulance “run sheets” if they did. They also told staff to bring patients directly into clinics or homes in case they were being followed by federal agents who would see patients walking or in wheelchairs.
The couple sought out dialysis patients and paid incentives to staff members who recruited new ones.
A superseding grand jury indictment in May 2007 alleged that the couple continued the practice while their case was in court by setting up a new ambulance company in their 20-year-old son’s name.
Investigators said A Care EMS Inc. fraudulently billed Medicare and Medicaid approximately $3 million and was paid $1.6 million between March 2005 and December 2006. The company used a rubber stamp with their son’s signature to continue the ruse.
Rodney Ramos, director of operations for A Care EMS, entered into a plea deal in September and is awaiting sentencing.