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RGV man convicted of conspiracy to commit health care fraud; payments were more than $1M

Posted at 12:27 PM, Apr 14, 2023
and last updated 2023-04-14 13:28:28-04

CORPUS CHRISTI, Texas — The owner of a home health care company based out of the Rio Grande Valley is headed to prison for conspiracy to commit health care fraud, according to a release from the United States Attorney's Office Southern District of Texas.

On Thursday, 44-year-old McAllen native Miguel Angel Contreras was sentenced to three years and nine months in prison after he plead guilty to his conspiracy charge on April 4..

He will also pay restitution for the more than $1 million as part of his sentence.

Contreras admitted he used his home health care company — Sambritt Home Health LLC — to submit 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."

Contreras also 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," the release states.

Contreras forged and/or told others to forge the signatures of physicians on 485 referral forms.

He directed employees to create “ghost notes” for patient files to make the claims look legitimate, according to the release.

Contreras also told his co-conspirators to bill Medicare for home health services with the referral forms, that did not have physician signatures.

The release states the false claims Contreras submitted to Medicare totaled $724,056.02, as Medicare paid out about $1,037,353.78 to Contreras's company.

Contreras remains on bond and must voluntarily surrender to go to a federal prison in the future.

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