Share PostA Garland doctor convicted in a scheme to use sham claims to siphon millions of dollars from the Centers for Medicare and Medicaid Services was sentenced this week to nearly five years in federal prison and ordered to pay a $9.5 million fine.
Dr. Nicolas Alfonso Padron, 54, pled guilty in September 2013 to a single count of conspiracy to commit healthcare fraud, which carries a maximum penalty of 10 years in prison, said U.S. Attorney Sarah Saldaña of the Northern District of Texas.
In the indictment, the feds alleged Padron partnered with Lawrence Dale St. John, 67, and his son Jeffrey Dale St. John, 42, owners of the Grand Prairie-based A Medical. The company sent physicians to the homes of Medicare beneficiaries rather than make them travel to a doctor’s office.
“Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient,” according to a release announcing the sentence.
Padron offered the father and son his unique Medicare ID number and allowed them to use it. From May 2010 until January 2012, the three filed $1.4 million in false Medicare claims that were either unnecessary or never happened at all. Other home health agencies billed Medicare an additional $9.7 million based off Padron’s fraudulent certifications.
The St. Johns would use Padron’s Medicare card number even when he was in another country, the feds say.
“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 release states.
The doctor is also awaiting sentencing after pleading guilty to selling Xanax and Hydrocodone to patients out of his office near White Rock Lake. According to media reports at the time, Padron filed 9,000 prescriptions in a year. A sentencing date has not been set.
The doctor will spend 57 months in federal prison and pay CMS $9.48 million in restitution. The St. Johns were convicted in October and will be sentenced on March 31.
The three were snagged in a wide net cast by federal authorities in Oct. 2012 that resulted in 91 indictments in Texas, Florida, New York, Illinois, California, and Louisiana.
The defendants collectively defrauded $429.2 million from Medicare, the feds say. Fourteen of them were from the Dallas area, including Arlington doctor Joseph Megwa, who Attorney General Eric Holder singled out during a press conference as the most egregious of all.
He was accused of defrauding CMS of more than $100 million.