Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 1 of 9 United States 0; 1 Southern W?g? UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF TEXAS AUG 1 8 2015 DIVISION Dam. Bridle? cm UNITED STATES OF AMERICA v. Criminal NO. EDUARDO CARRILLO MARTHA URIBE MEDRANO SUPERSEDING INDICTMENT THE GRAND JURY CHARGES: At all times material to this Indictment: THE MEDICARE PROGRAM 1. The Medicare program (Medicare) is a federally ?mded health care program designed to provide medical care to individuals over age 65 and individuals with disabilities. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), a federal agency under the US Department Of Health and Human Services (HHS). Medicare is a ?health care bene?t program? as de?ned by Title 18, United States Code, Section 24(b) and as de?ned by Title 42, United States Code, Section in that, it was a plan or program that provided health care bene?ts, whether directly, through insurance, or otherwise, which was funded directly, in whole or in part, by the United States Government. 2. Medicare is divided into multiple Parts: Medicare Part A (hospital insurance) and Medicare Part (medical insurance). Medicare Part A covers inpatient hospital, inpatient skilled nursing, inpatient hospice, and some home health care services. 1 Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 2 of 9 Medicare Part covers physician?s services and outpatient bene?ciary care, including some home health care services. Among the types of reimbursable medical assistance available to covered persons is Home Health Care. 3. Individuals who qualify for Medicare bene?ts are commonly referred to as 33 ?bene?ciaries. Each bene?ciary is given a Medicare identi?cation number, referred to as a Health Insurance Claim Number (HICN). 4. Home Health companies, pharmacies, physicians, and other health care providers that provide services to Medicare bene?ciaries are referred to as ?providers.? To participate in Medicare, a provider is required to submit an application in which the provider agrees to comply with all Medicare related laws and regulations. If Medicare approves a provider?s application, Medicare assigns the provider a National Provider Identi?cation (NPI) number. A health care provider with a Medicare NPI number can ?le claims with Medicare to obtain reimbursement for medically necessary services rendered to bene?ciaries. Once Medicare approves a provider?s application, the provider is supplied with a current copy of the Medicare Part A and Part Provider Manuals. In addition, Medicare provides further guidance and updates in the form of bullets and newsletters which are distributed to health care providers. The Medicare Provider Manuals, bulletins, and newsletters contain the laws, rules, and regulations pertaining to Medicare-covered services including those rules and regulations regarding the requirements pertaining to providing and billing for home health care. Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 3 of 9 THE DEFENDANTS 5. Defendant EDUARDO CARRILLO was a resident of Hidalgo County, Texas and was licensed as a physician in the state of Texas. 6. On or about November 23, 2004, defendant EDUARDO CARRILLO became enrolled as a provider in the Medicare program. National Provider Identi?er (N PI) 1316962566 was assigned to defendant EDUARDO CARRILLO. On or about July 24, 2012, defendant EDUARDO CARRILLO, on behalf of Renuevate PA, became enrolled as a provider in the Medicare program. National Provider Identi?er (NPI) 1487900718 was assigned to defendant EDUARDO CARRILLO, CEO. 7. Defendant MARTHA URIBE MEDRANO was a resident of Hidalgo County, Texas and was employed as an assistant or administrator at the doctor?s of?ce of the defendant EDUARDO CARRILLO. SCHEME T0 DEFRAUD 8. In order to execute and carry out their illegal activities, the defendants committed the following acts: In violation of Medicare guidelines and the anti-kickback statute, the defendants executed a scheme whereby they solicited and obtained illegal kickbacks, speci?cally cash money, in exchange for patient referrals to prospective home health agencies. It was the object of the scheme to defraud for the defendants to unlawfully enrich themselves by receiving kickbacks in exchange for the referral of Medicare bene?ciaries, whose information would be used by home health agencies to bill Medicare for a variety of health care items and/or services. Defendant Carrillo illegally solicited and was paid $3,000 cash in exchange for the future referral of 13 to 15 Medicare patients. The agreement was written down by Defendant Carrillo on a prescription pad containing his name. The prescription pad was then signed by Defendant Carrillo. Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 4 of 9 (0) Defendant Carrillo and Defendant Medrano illegally solicited and were paid $3,000 cash in exchange for additional Medicare patient referrals. In return for the payment, Defendant Medrano supplied prospective home health agency employees with patient referral forms containing Defendant Carrillo?s signature and the patient?s name, social security number, and Medicare number. During and in relation to their fraudulent conduct, the defendants knowingly transferred, possessed, or used or knowingly caused others to transfer, possess, or use, without lawful authority, one or mean of identi?cation of Medicare bene?ciaries which they used to execute their scheme and arti?ce to obtain illegal kickbacks. (6) Defendant Carrillo attempted to cause others to ?le claims and caused others to ?le claims with Medicare for reimbursement of physician services which were not provided. Speci?cally, Defendant Carrillo submitted fraudulent documentation . to a billing company so that the billing company would ?le claims with Medicare for physician services allegedly provided by the defendant for 34 patients who were in fact deceased and could not have possibly been treated by the defendant. Records obtained show that the 34 patients were deceased on the dates that Defendant Carrillo claimed to have provided services to the patients. By submitting the fraudulent documentation to the billing company, the defendant attempted to cause and caused the billing company to ?le claims with Medicare knowing that said claims were false and fraudulent since the physician services were not provided. From on or about June 8, 2015, through on or about July 29, 2015, Defendant Carrillo attempted to cause others to submit false or fraudulent claims in the aggregate sum of $17,170.00 to Medicare, for physician services which were not provided. COUNT ONE ILLEGAL REMUNERATIONS (Violation of 42 U.S.C. The Grand Jury incorporates by reference paragraphs 1 through 8 as though fully restated and re-alleged herein. 10. On or about December 22, 2011, in the McAllen Division of the Southern District of Texas and elsewhere within the jurisdiction of the Court, the exact dates being unknown to the Grand Jury, defendant, Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 5 of 9 EDUARDO CARRILLO did knowingly and willfully solicit or receive remuneration, including a kickback, bribe, and rebate, directly and indirectly, overtly or covertly, in cash and in kind, from one another, in the form of a $3000 cash kickback in exchange for the referral of 13 to 15 Medicare bene?ciaries, for the furnishing and the arranging of the furnishing of any item and service for which payment may be made in whole and in part under a Federal health care program. In violation of Title 42, United States Code, Section COUNT TWO FALSE STATEMENT 11. The Grand Jury incorporates by reference paragraphs 1 through 8 as though fully restated and re-alleged herein. 12. On or about April 5, 2012, in the McAllen Division of the Southern District of Texas and elsewhere within the jurisdiction of the Court, the exact dates being unknown to the Grand Jury, defendant, EDUARDO CARRILLO did knowingly and willfully make and cause to be made a materially false, ?ctitious, and fraudulent statement and representation in a matter within the jurisdiction of a department or agency of the Government of the United States, namely, the Health and Human Services Of?ce of the Inspector General (HHS-01G), by informing HHS-01G Special Agents Mario Fuentes and Yolanda Lucio that he did not receive any money or was not offered any ?nancial consideration in exchange for the referral of patients, when in truth and fact, the statement and representation were false because, the defendant did receive $3000 in exchange for the referral of 13 to 15 patients. 5 Case 7:15-cr-00761 Document 36 Filed on 08/18/15 in TXSD Page 6 of 9 In violation of Title 18, United States Code, Section 1001. COUNTS THREE THROUGH FOUR ILLEGAL REMUNERATIONS 13. The Grand Jury incorporates by reference paragraphs 1 through 8 as though fully restated and re-alleged herein. 14. Beginning on or about August 21, 2012, through on or about October 24, 2012, in the McAllen Division of the Southern District of Texas and elsewhere within the jurisdiction of the Court, the exact dates being unknown to the Grand Jury, defendants, EDUARDO CARRILLO and MARTHA URIBE MEDRANO aiding and abetting one another, did knowingly and willfully solicit or receive remuneration, including a kickback, bribe, and rebate, directly and indirectly, overtly or covertly, in cash and in kind, from one another, in the form of a $3000 cash kickback, in exchange for the referral of Medicare bene?ciaries, for the furnishing and the arranging of the furnishing of any item and service for which payment may be made in whole and in part under a Federal health care program, including, but not limited to the following: Count Patient Date of Alleged Amount received Method of referral Patient Referral for patient (On or about) referrals Patient referral form for home health services, 3 AV. 10/24/12 $3,000 containing patient?s identifying information and Medicare number Patient referral form for home health services, 4 A.A. 10/24/ 12 $3,000 containing patient?s identifying information and Medicare number Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 7 of 9 All in violation of Title 42, United States Code, Section and Title 18 United States Code, Section 2. COUNTS FIVE THROUGH SIX AGGRAVATED IDENTITY THEFT 15. The Grand Jury incorporates by reference paragraphs 1 through 8 as though fully restated and re-alleged herein. 16. Beginning on or about August 21, 2012, through on or about October 24, 2012, in the McAllen Division of the Southern District of Texas and elsewhere within the jurisdiction of the Court, the exact dates being unknown to the Grand Jury, defendants, EDUARDO CARRILLO and MARTHA URIBE MEDRANO during and in relation to a felony violation of Title 42, United States Code, Section Illegal Remunerations, aiding and abetting one another, did knowingly transfer, possess, or use, without lawful authority, a means of identi?cation of another person, including but not limited to the following: Count Patient Date of Alleged Amount received Means of ID Used Patient Referral for patient Without Lawful Authority (On or about) referrals 5 AV. 10/24/12 $3,000 Patient?s identifying information and/or Medicare Number Patient?s identifying information and/or 6 AA. 10/24/12 $3,000 Medicare Number All in violation of Title 18, United States Codes, Sections 1028A and 2. Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 8 of 9 COUNTS SEVEN THROUGH TWELVE HEALTH CARE FRAUD 17. The Grand Jury incorporates by reference paragraphs 1 through 8 as though fully restated and re-alleged herein. 18. Beginning on or about June 8, 2015 through July 29, 2015, in the McAllen Division of the Southern District of Texas and elsewhere within the jurisdiction of the Court, the exact dates being unknown to the Grand Jury, defendant EDUARDO CARRILLO did knowingly and willfully execute or attempt to execute a scheme or arti?ce to defraud the health care bene?t program known as Medicare, or to obtain by false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of the health care bene?t program known as Medicare, in connection with the delivery of, or payment for, health care bene?ts, items, or services. Defendant submitted, aided, abetted, counseled, commanded, induced, procured or otherwise facilitated and caused others or attempted to cause others to submit false and fraudulent claims to Medicare, for medical bene?ts, items, and services which were not provided, including, but not limited to the following: Count Patient Last 5 Digits Date of Date Claim Was Reason Attempted Claim Was of Patient Alleged Presented by False and Fraudulent Medicare Service Defendant to Biller Number to Submit for Payment Patient was deceased on the date of 7 .M. 3596A 7/2/2015 7/17/2015 alleged service and could not have been treated by the defendant. Patient was deceased on the date of 8 LC. 5121A 7/2/2015 7/17/2015 alleged service and could not have been treated by the defendant. Case 7:15-cr-OO761 Document 36 Filed on 08/18/15 in TXSD Page 9 of 9 Count Patient Last 5 Digits Date of Date Claim Was Reason Attempted Claim Was of Patient Alleged Presented by False and Fraudulent Medicare Service Defendant to Biller Number to Submit for Payment Patient was deceased on the date of 9 .A. 8679A 7/2/2015 7/17/2015 alleged service and could not have been treated by the defendant. Patient was deceased on the date of 10 M.V. 1347A 7/7/2015 7/17/2015 alleged service and could not have been treated by the defendant. Patient was deceased on the date of 11 AC. 8314A 7/ 15/2015 7/17/2015 alleged service and could not have been treated by the defendant. Patient was deceased on the date of 12 HR. 209B1 7/15/2015 7/ 17/2015 alleged service and could not have been treated by the defendant. KENNETH MAGIDSON UNITED STATES ATTORNEY 74.445) ASSISTANT UNITEWATES ATTORNEY All in violation of Title 18, United States Codes, Section 1347. A TRUE BILL FOREPERSON