McALLEN — A South Padre Island woman stands charged with participating in a large scale kickback conspiracy meant to defraud federal and private health insurers via the unnecessary prescription of compound drugs.
Nora Alaniz, 56, made her initial appearance in McAllen federal court Monday morning. She stands charged with conspiring to pay and receive kickbacks in exchange for using her home health care agency, Manos de Oro, to facilitate the referral of the fraudulent prescriptions.
Alaniz’s arrest last Friday represents just the latest development in a yearlong prosecution of the scheme, which has thus far involved eight named defendants since the original indictment was unsealed last June.
The indictment also intimates the involvement of at least four physicians, a nurse practitioner, and a member of the military.
In total, federal prosecutors claim the far-reaching scheme netted $110 million by billing federal and private insurance companies for compound medications that were neither medically necessary nor wanted by their patients.
Alaniz’s alleged involvement in the conspiracy began in late 2016, when she met with an unnamed pharmacist — referred to in court documents as Pharmacist-1 — with promises that a local doctor, Tajul Shams Chowdury, could send prescriptions for pricey compound drugs his way.
In turn, the pharmacist could profit off the referrals by billing the high priced — but medically unnecessary — custom formulated drugs to private insurance companies, Medicare and TRICARE, a federal health insurance program for Department of Defense employees.
The pharmacist agreed to the scheme and began paying Alaniz kickbacks within a month of joining onto the conspiracy, according to a 16-count superseding indictment that was unsealed last Tuesday.
By the time Alaniz met with the pharmacist in December 2016, however, the conspiracy had already proven quite lucrative, netting millions for the conspiracy’s existing participants up to that point, court records show.
Prosecutors allege that the doctor that Alaniz had introduced to the unnamed pharmacist, Chowdhury, was an integral part of the conspiracy; however, he was not the mastermind of the scheme.
Instead, that role was allegedly filled by John Aguedo Rodriguez, a pharmacist and owner of Pharr Family Pharmacy on South Cage Boulevard in Pharr.
According to the superseding indictment, it was Rodriguez who recruited nearly each member of the conspiracy, including Chowdhury and his son, Mohammad Imitiax Chowdhury.
The younger Chowdhury purportedly worked as a “marketer” for Rodriguez, but he wasn’t the only one.
Prosecutors say Rodriguez recruited other “marketers,” including chiropractors Alex Flores Jr. and Hector DeLaCruz Jr. (sic), and two individuals identified in court documents only by their initials, “V.G.” and “J.Y.”
“John Aguedo Rodriguez directed the purported marketers to target specific health care benefit programs that paid high reimbursements for compound drugs, including but not limited to compound pain creams, scar creams, vitamins, and other prescription items, such as pain patches,” the superseding indictment states, in part.
Rodriguez allegedly paid his team of marketers kickbacks, which he directed them to obscure as legitimate payments for consulting and other services, court records show.
The marketers, in turn, accepted kickbacks from the doctors and other providers they had convinced to fraudulently prescribe the unneeded drug formulations.
The conspiracy eventually evolved from the small network of healthcare providers with their existing practices, to the opening of clinics specifically for the purpose of furthering the fraud.
“Purported marketer, J.Y., opened and operated a clinic with the purpose and intent of generating high-reimbursing prescriptions for compound drugs to send to PFP,” the indictment states.
J.Y. later recruited a member of the military, identified in court documents as “Soldier-1.”
Soldier-1 was a patient who allegedly agreed to accept kickbacks in exchange for referring other members of the military and their families to the Pharr Family Pharmacy.
In all, the web of conspirators allowed Rodriguez to bill $95 million worth of prescriptions to the Federal Employees’ Compensation Act Program, which provides benefits for federal employees who have been injured on the job.
FECA paid $41 million as a result of Rodriguez’s prescription billings.
Two other federal healthcare benefit providers, TRICARE and Medicare, paid another $15 million in claims.
In turn, Rodriguez distributed some $6.6 million in kickbacks to Mohammad Chowdhury — who allegedly turned around and paid some of that money to his father — and $8 million to the two chiropractors, Flores and DeLaCruz.
Another $7.6 million in kickbacks went to V.G., $1.3 million to J.Y., and $700,000 to a Pharr Family Pharmacy employee pseudonymously known as “M.V.C.”
In the latest charge to be handed up by the grand jury, Alaniz is accused of accepting more than $70,000 in kickbacks.
Four of the named members of the conspiracy have pleaded guilty to their roles in the scheme and await sentencing.
They include Flores and DeLaCruz, a woman named Erika Sanchez Vasquez, and the woman prosecutors claim Alaniz paid kickbacks to as part of her role in the scheme: Araceli Gaona.
Alaniz was released from custody Monday afternoon on a $50,000 unsecured bond. She is expected to be arraigned Friday morning.
Meanwhile, the remainder of the defendants named in the superseding indictment — including Rodriguez and the Chowdhurys — were set to be jointly arraigned Tuesday; however, court records show they have waived a reading of the indictment and have pleaded not guilty.
