Texas Doctor Admits Medicare Billing Scam

CORPUS CHRISTI, TEXAS — Dr. Roque Joel Ramirez, 49, of Robstown, has entered a plea of guilty to mail fraud in connection with his scheme to defraud Medicare and Medicaid through fraudulent billings, announced U.S. Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.

Ramirez, a licensed physician in Texas since 1997 and owner of Health Resolutions Inc., was indicted by a federal grand jury on October 9, 2013, in a scheme to defraud Medicare and Medicaid through fraudulent billings. He was set for trial but opted to enter a guilty plea to one count of mail fraud for using the U.S. Postal Service to execute his scheme. His medical office in Corpus Christi is now closed.

Ramirez admitted he knowingly and willfully engaged in a scheme to defraud Medicare and Texas Medicaid and submitted false and fraudulent billings for medical services he did not provide. He also admitted he committed mail fraud by using the USPS to receive payment on the fraudulent bills.

Court documents indicated that Ramirez knowingly and willfully engaged in the scheme from May 2008 through December 2011 by submitting fraudulent billings for physician services he did not provide. Thousands of false and fraudulent bills were submitted, according to the charges. Ramirez billed for medical services he claimed he personally provided to patients who had actually died prior to the dates of his claimed services. He also submitted bills claiming he personally provided services to patients at his clinic when he was actually overseas or in another state. Some of the bills also indicated he would have personally worked more than 24 hours in a single day. Court documents also alleged that when he provided medical services to Medicare and Medicaid patients in nursing homes, he would send fraudulent bills claiming he had seen the patients in private residences in order to collect the higher fees paid for house calls.

Ramirez faces up to 20 years in federal prison and a $250,000 maximum fine.

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

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