North Texas Men Convicted of Healthcare Fraud

Two Grand Prairie men have been convicted of healthcare fraud for their roles in a Medicaid scam that netted the father-son pair $1.4 million in fraudulent payments.

Earlier this month, a jury found 66-year-old Lawrence Dale St. John and 41-year-old Jeffrey Dale St. John guilty of a host of charges, including conspiracy to commit healthcare fraud, prosecutors announced last week. The St. Johns operated a company called A Medical House Calls, which claimed to provide services to in-home Medicare beneficiaries. Instead, the duo bilked taxpayers and the Medicaid system for more than a $1 million in bunk payments.

A Medical, which provided physician home visits to Medicare beneficiaries, was also known as A+ Medical House Calls and ANM Physician House Calls. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services. A Medical did not provide primary care physician services to Medicare beneficiaries, although many patients believed the company was a real physician practice and attempted to get care, often to no avail. Dr. Nicolas Padron, 53, of Garland, served as its medical director, and supplied his Medicare provider number to the St. Johns so that A Medical could submit claims to Medicare. Padron was also charged in connection with the scheme.

The indictment alleged that from May 2010 through Jan. 5, 2012, the defendants conspired together to bill Medicare for care plan oversight by Dr. Padron for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise.

The case was part of an October 2012 national sweep involving $429.2 million in alleged Medicare fraud mounted by Justice Department task forces in cases in Dallas, Houston, Miami, Brooklyn, Chicago, Los Angeles and Baton Rouge, La. Ninety-one defendants were indicted, including 14 in the Dallas area. The largest local case involved Dr. Joseph Megwa, 58, of Arlington’s Raphem Medical Practice. At a news conference, Attorney General Eric Holder said the physician was responsible for over $100 million in home healthcare fraud.

Megwa signed off on $90.5 million in false or unnecessary claims for home healthcare visits and wrote 33,000 prescriptions from PTM Healthcare Services of Irving and at least 230 other home health care agencies in the Dallas area. Megwa billed Medicare for $10 million more in fraudulent personal fees.

The indictments were part of a nationwide effort by the federal department of Health and Human Services, the FBI, Texas’ Medicaid Fraud Control Units, and U.S. Attorney’s Offices to crack down on fraud using stolen identities, Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General said at the time.

“In one of the cases, the defendants submitted claims for services to Medicare patients whose only connection to the defendants were that their names happened to be on a list of stolen Medicare ID numbers the defendants had obtained,” Fields said then. “The patients never visited the defendants’ business and never received any of the diagnostic tests and office visits for which their Medicare benefits were charged.”

The St. Johns face up to 10 years in prison on each count and a $250,000 fine when they’re sentenced in January.

Read the full indictment of the St. Johns and Padron below.

Federal St. John Indictment

Posted in Government/Law, News.