McALLEN — New details have emerged in the healthcare fraud allegations against Dr. Osama Bachir Nahas and one of his employees after they made their first appearances in federal court on Monday.
Nahas, 67, and Isabel Moreno Pruneda, 50, are accused of bilking Medicare out of at least $3.5 million by fraudulently billing for unnecessary services and prescriptions. The pair allegedly did so by targeting elderly and disabled patients who attended local adult daycare facilities.
But as revealed in a 15-count indictment against them — which was unsealed Monday — many of those patients were incapable of understanding what was being done to them.
“Many of the patients examined by Osama (Bachir) Nahas at adult day care facilities lacked the capacity to consent to examinations, tests or other procedures,” the indictment states, in part.
“…Nahas did not obtain the consent of guardians or caretakers prior to performing such examinations, tests, or other procedures,” it further states.
Nahas and Pruneda are accused of working with two unnamed coconspirators referred to in the indictment as “Marketer-1” and “Marketer-2” in referring patients for unneeded laboratory testing and prescriptions.
Marketer-1, who was affiliated with several lab testing companies, would allegedly pay kickbacks to Nahas in exchange for ordering lab tests for the adult daycare patients.
“Marketer-1 and Osama (Bachir) Nahas falsely disguised kickback payments as payments for office and equipment rental,” the indictment states.
Meanwhile, Marketer-2 allegedly paid kickbacks to Pruneda in exchange for sending patient prescriptions to a pharmacy in San Antonio.
Pruneda allegedly did so without the patients’ knowledge that prescriptions were being ordered in their names with forged documents, or that those medications were then being sent to Nahas’ Edinburg office, Crosspoint Medical Clinic.
“…Pruneda, and others known and unknown, misappropriated the medication intended for the patient, at times providing the patient with a small portion of the medication for which Medicare was billed, or failing to provide the patient with any medication at all,” the indictment reads.
It’s unclear what happened to the medications that were not dispensed to patients.
Pruneda also allegedly forged patient signatures in order to obtain urine and blood specimens for tests that were sent to labs associated with Marketer-2.
However, the results of those tests never made it to the patients or their primary care doctors, who were likewise unaware of what was occurring.
According to federal prosecutors, the scheme lasted for two years — from January 2016 to about December 2018.
That timeline makes clear that the federal allegations against Nahas are separate from a host of similar criminal charges he faced in state court just a few years ago.
State grand juries handed up two separate indictments against the doctor in 2017 and 2019 alleging he had committed Texas Medicaid fraud from Jan. 1, 2009 through Feb. 27, 2012, and from Jan. 1, 2011 through July 31, 2012, respectively.
Nahas avoided trial in both instances.
The two first-degree felony counts levied against him in 2017 were later dismissed “in the interest of justice,” according to court records.
Meanwhile, the four second-degree felony counts he faced in 2019 were dismissed at the request of the Texas Attorney General’s Office last August after Nahas agreed to pay more than $44,000 in restitution.
A man named Gerardo J. Jackson — who was separately charged as Nahas’ coconspirator in 2019 — also avoided jailtime in exchange for paying restitution.
In the current case, Nahas and Pruneda face 15 charges, including one count of conspiracy to commit healthcare fraud, seven counts of healthcare fraud, six counts of aggravated identity theft, and one count of conspiracy to pay and receive illegal remunerations.
They face up to 10 years in prison on each of the first eight counts of healthcare fraud, two years in prison on each of the identity theft charges, and up to five years in prison for accepting kickbacks or bribes. They also face fines of up to $250,000.
Both are being held in federal custody after prosecutors raised concerns that they may be flight risks.
“He does have significant international ties,” Assistant U.S. Attorney Andrew R. Swartz said, referring to Nahas, who was born in Syria.
As for Pruneda, she has “multiple convictions for bail jumping,” Swartz said.
The pair are due back in court Tuesday afternoon for bond and detention hearings.
