October 17, 2012
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Edinburg Woman Convicted of Health Care Fraud Following State and Federal Probe

The U.S. Attorney for the Southern District of Texas issued the following news release on Oct. 16, 2012:

Former biller for Marcelo Herrera doing business as RGV DME Convicted

McALLEN – Beatriz Ramos, 28, of Edinburg, a former biller for RGV DME, a now defunct McAllen area durable medical equipment (DME) business, pleaded guilty today for her role in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.

Ramos, a former biller for Marcelo Herrera who did business as RGV DME was charged along with Herrera, 39, his wife Carla Cantu Herrera, 31, and Ramon De La Garza, 51, all of Mission, in a 22-count federal indictment on June 26, 2012. The charges included one count of conspiracy to commit health care fraud, six counts of health care fraud, five counts of wire fraud and 10 counts of aggravated identity theft.

Ramos appeared in front of United States District Judge Micaela Alvarez this afternoon and entered a plea of guilty to conspiring with Marcelo Herrera, his wife and De La Garza to submit false and fraudulent claims to Medicare and Medicaid. Ramos admitted bills were sent to Medicare and to Medicaid for DME that was never prescribed, never delivered and not needed. Ramos also admitted that to conceal their fraud, she and her co-defendants forged and falsified documents and illegally used the identities of beneficiaries and doctors on their unlawful billings.

The indictment alleges Marcelo Herrera doing business as RGV DME submitted approximately 25,000 claims totaling approximately $11 million to Medicare and Texas Medicaid for DME allegedly provided to Medicare and Medicaid beneficiaries and was paid more than $7.1 million. Ramos admitted that 80 to 90 percent of the billings were fraudulent and that the fraudulent claims to Medicare were sent by wire transmissions in interstate commerce.

Ramos faces up to 10 years in federal prison and a possible $250,000 fine for conspiracy to commit health care fraud. Ramos remains free on bond pending sentencing which is scheduled for Jan. 16, 2013.

Jury selection for the trial of the remaining defendants is set for Nov. 6, 2012. Marcelo Herrera and De La Garza remain in custody pending trial, while Carla Cantu Herrera was permitted to remain on bond.

The investigation leading to the charges was conducted by the U.S. Department of Health and Human Services-Office of Inspector General, FBI and the Texas Attorney General’s Medicaid Fraud Control Unit.

Special Assistant United States Attorney Rex Beasley and Assistant United States Attorney Grady Leupold are prosecuting the case.