Doctor Gets 70 Months for Medicaid Fraud

     (CN) – A Houston doctor was sentenced to 5 years and 10 months in prison and ordered to pay $3.8 million in restitution for mail fraud and conspiracy. Armando Chavez, 42, owner of the Chavez Medical Group, was charged by criminal information in April, waived indictment and pleaded guilty to one count of conspiracy and three counts of mail fraud.



     Chavez was sentenced Monday in Houston by U.S. District Judge David Hittner.
     The charges stemmed from improper billing at the Chavez Medical Group from 2005 to 2007.
     Prosecutors said Chavez billed for services he did not perform by fraudulently “unbundling” medical codes on claims he filed to increase his take from insurers.
     Chavez billed insurance companies, Medicare and Medicaid $14.1 million during the period, and was paid $3.8 million, according to the U.S. attorney.
     After the investigation began, Chavez voluntarily surrendered his medical license to the Texas Board of Medicine.
     Chavez was board certified in internal medicine and licensed by the Texas Board of Medicine in 1997. He started his medical practice in family medicine and in 2005 began to perform endovenous laser ablation to repair varicose veins in the legs.
     “Chavez submitted claims alleging he repaired all six veins for each patient, when in fact – in most cases – he repaired fewer than six veins,” the U.S. Attorney’s Office said in a statement.
     “By alleging he repaired all six veins, Chavez alleged he performed six procedures over a period of six days, another aspect of the fraudulent billing which he used to justify the unbundling of codes and allowed him to be reimbursed at the highest possible rate.”
     A typical patient whose billing was submitted as bundled into one code resulted in around $6,000 in payments, while a patient whose billing codes were unbundled resulted in payment of approximately $14,000, prosecutors said.
     Chavez remains free on bond awaiting an order to surrender to federal prison.

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