Federal Investigators Claim 12 Defendants Defrauded Medicare of $100 Million in Texas

In the latest big health care fraud case to hit Texas, 12 defendants have been arrested on a variety of charges outlined in five federal indictments.

Federal authorities are alleging the defendants made $100 million in fraudulent billings to Medicare, according to U.S. Attorney Sarah Saldaña of the Northern District of Texas.

“Over the last 18 months the Medicare Fraud Strike Force in Northern District of Texas has charged defendants with close to one half billion dollars of fraud and have sent a clear message that we will protect taxpayers’ dollars and the Medicare program,” Saldaña, said in a statement.

“Today’s indictments are part of a nationwide effort by HHS-OIG, the FBI, state Medicaid Fraud Control Units and U.S. Attorney’s offices to crack down on the most virulent form of health care fraud, fraud using stolen identities,” Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General said in a statement on October 4.

“In one of the cases charged today, the defendants submitted claims for services to Medicare patients whose only connection to the defendants were that their names happened to be on a list of stolen Medicare ID numbers the defendants had obtained. The patients never visited the defendants’ business and never received any of the diagnostic tests and office visits for which their Medicare benefits were charged.”

Defendants include Lawrence Dale St. John, his son Jeffrey Dale St. John and Dr. Nicolas Alfonso Padron who are each charged with one count of conspiracy to commit health care fraud and 13 substantive counts of health care fraud. Dr. Padron has been held in federal custody since his arrest in June 2012 on charges related to his role in an alleged conspiracy to illegally distribute and dispense hydrocodone, according to the federal authorities.

Pamela Adenuga, 38, and her husband, Kahinde Adenuga, 45, both of Arlington, Texas are each charged with one count of conspiracy to commit health care fraud and seven substantive counts of health care fraud.

Healthcare fraud has become one of the hottest areas of federal law enforcement in recent months as the Obama administration embarks on sweeping reforms to the system.

In a case in Texas earlier this year, the FBI announced the arrest of Dr. Emmanuel Nwora, 48, of Houston, who is accused of health care fraud and conspiracy to commit health care fraud.

The indictment also charged Charles Harris, 52. It alleges that for three years from 2007 to 2010, the two men falsely billed Medicare and Medicaid using vestibular diagnostic codes. The indictment claimed they billed Medicare and Medicaid about $850,000 and were paid $390,000.

While healthcare fraud is a high priority area of law enforcement carrying stiff penalties, the pressure being put on federal agents to get results in this area carries inherent dangers.

When agents are asked to prioritize a law enforcement area from above, there is inevitably pressure for results and the potential for miscarriages of justice. With these federal offenses carrying such significant penalties, it’s important to make sure agents don’t become too zealous in the rush to get results.

Mick Mickelsen is a nationally recognized criminal trial attorney with more than 30 years of experience defending people charged with white-collar crimes, drug offenses, sex crimes, murder, and other serious state and federal offenses.