McAllen doc, Edinburg medical assistant convicted of healthcare fraud

Osama Balhir Nahas and Isabel Moreno Pruneda
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A federal jury convicted a McAllen doctor and an Edinburg medical assistant following three hours of deliberations on Friday in a multimillion dollar healthcare fraud scheme.

The convictions follow seven days of trial over two weeks in McAllen federal court.

Osama Nahas, 69, was convicted of conspiracy to commit healthcare fraud, healthcare fraud and conspiracy to violate the Anti-Kickback Statute.

Isabel Pruneda, 53, was also convicted of those charges, as well as an additional count of identity theft.

The scheme included illegal kickbacks after ordering unnecessary prescriptions and lab tests, according to a news release for the U.S. Attorney’s Office for the Southern District of Texas.

Nahas owns the Crosspoint Medical Clinic in Edinburg and is its physician.

“He would travel to adult day care centers around the Rio Grande Valley ordering unnecessary lab tests and prescriptions on behalf of elderly and vulnerable clients who were spending time there,” the release stated.

Pruneda worked at Crosspoint Medical Clinic as a medical assistant and assisted Nahas by forging patient signatures on consent forms and misappropriating expensive patient medications like pain creams.

“Among other things, Pruneda would strip patient information off and remove creams from their boxes so that she could hand them out as ‘goodie bags’ to incentivize patients to be tested,” the release stated.

The scheme resulted in millions of dollars in losses between January 2016 and December 2017 as Nahas and Pruneda directed prescriptions and tests to companies who paid them in kickbacks.

“In June 2018, law enforcement executed a search warrant at Crosspoint and found hundreds of thousands in stolen medications,” the release stated.

The doctor and medical assistant also bribed their way into adult day care facilities with kickbacks to the owners of those facilities disguised as “rent” payments.

“The jury heard witness testimony revealing both Nahas and Pruneda accepted bribes in exchange for referrals, many of which were also disguised as ‘rent’ payments,” the release stated.

That document says that both Nahas and Pruneda received tens of thousands of dollars in kickbacks from January 2016 to 2017.

Nahas tried to convince the jury that the “rent payments were legitimate and that Pruneda ordered the lab tests and prescriptions without his consent. Pruneda argued that she was following Nahas’ orders and denied committing forgery.

“The jury did not believe those claims and found both guilty as charged,” the release stated.

U.S. Attorney Alamdar S. Hamdani, for the Southern District of Texas, said adult day cares are supposed to be places where elderly and vulnerable people feel safe, not spaces for doctors and staff to make illegal profits through kickbacks and “get-rich opportunities.”

“Nahas and Pruneda preyed on the elderly by bribing their way into adult care facilities, abusing the trust and respect that doctors and medical professionals ordinarily deserve,” Hamdani said in the release. “Today’s conviction sends a message that patients should never be seen merely as dollar signs and that kickbacks play no role in the services that doctors order.”

Pruneda and Nahas are scheduled to be sentenced in May where they face up to 10 years in prison for the healthcare fraud conspiracy conviction and for each substantive healthcare fraud conviction. The kickback conspiracy carries up to five years. Pruneda’s aggravated identity theft charge is a mandatory two years that must be served consecutively with any other sentence imposed.

Fines of up to $250,000 for Pruneda and Nahas are also possible.

Pruneda was taken into custody following the deliberations while Nahas was allowed to remain on bond.

Detention hearings are scheduled for next week.