An Edinburg physician and one of his employees were arrested by federal agents Friday on multiple charges of health care fraud, conspiracy to receive illegal remuneration and aggravated identity theft.
A federal grand jury handed up a 15-count indictment against Dr. Osama Balhir Nahas, 67, and his employee, Isabel Moreno Pruneda, 50, on Tuesday, according to a news release from the U.S. Attorney’s Office. The indictment has yet to be unsealed.
The pair are accused of participating in a conspiracy that resulted in some $3.5 million in fraudulent claims billed to Medicare via Nahas’ medical practice at Crosspoint Medical Clinic in Edinburg.
“Nahas allegedly paid kickbacks to various adult day care companies to gain Medicare beneficiary information under the guise of providing medical services,” the news release states.
“Nahas, Pruneda and other co-conspirators used their access to adult day care facilities to perform a variety of unnecessary medical tests and procedures and order prescriptions for expensive medications that were not needed,” it further states.
The alleged scheme targeted elderly and disabled patients, many of whom already had primary care physicians who were unaware of the examinations Nahas and his co-conspirators were conducting on them.
Both the doctor and Pruneda also allegedly accepted kickbacks from “marketers” who ordered laboratory tests and prescriptions that weren’t needed or wanted by the patients. In furtherance of the scheme, Pruneda allegedly forged patient consent forms for the tests.
Both Nahas and Pruneda are each charged with seven counts of health care fraud and conspiracy to commit heath care fraud, as well as one count of conspiracy to receive illegal remunerations. They face up to 10 years in prison for the first seven counts, and up to five years for the latter count.
They are also both charged with aggravated identity theft, which carries a mandatory minimum sentence of two years in prison.
This is not the first time Nahas has found himself — and his medical practice — at the center of fraud allegations.
In 2017, and again in 2019, the doctor was charged with similar crimes by state officials.
On May 9, 2017, Nahas was indicted on two counts of Medicaid fraud resulting in $200,000 or more in fraudulent billings, a first-degree felony.
The scheme allegedly took place between Jan. 1, 2009 and Feb. 27, 2012.
According to the indictment, Nahas knowingly billed Medicaid for physical therapy sessions that were carried out by unlicensed practitioners.
He also submitted “claims with a false place of service location… that permitted Crosspoint Medical Clinic to receive payment under the Texas Medicaid program that it was not authorized to receive or that was greater than the payment that was authorized.”
Both charges were dismissed the following year, on May 10, 2018, “in the interest of justice,” according to court records.
But less than a year later, on March 19, 2019, a new grand jury returned a four-count indictment against Nahas, as well as a separate one-count indictment against his co-conspirator, Gerardo J. Jackson.
In this second indictment against the doctor, he was again accused of ordering physical therapy sessions for his patients that were conducted by employees who “did not hold licenses to perform physical therapy and had not received formal training or study.”
The doctor also did not obtain the patients’ consent for the treatments.
Nahas submitted between $20,000 and $100,000 in fraudulent bills to Medicaid during the scheme, which lasted from Jan. 1, 2011 through July 31, 2012, according to the second indictment.
But again, the doctor avoided trial and, potentially, jail time.
Instead, all four of the 2019 charges — each 2nd degree felonies — were dismissed on Aug. 4, 2021 at the request of the Texas Attorney General’s Office in exchange for Nahas’ agreement to pay $44,421.80 in restitution.
His co-conspirator, Jackson, received the same deal.
It remains unclear, however, if the federal charges announced against Nahas on Friday are new allegations, or if they came as a result of the so-called “dual sovereignty doctrine,” which allows the federal government to pursue criminal charges based on the same crimes that have previously been prosecuted by the state.
The U.S. Supreme Court has held that the federal and state governments each have independent “sovereignty” to prosecute the same offense without violating double jeopardy.
Nahas and Pruneda are expected to make their initial appearances before a federal magistrate judge on Monday morning.