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Swag Bags For Fraud

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Day care is a real need for the elderly. Dr. Osama Nahas knew that as the owner and physician of Crosspoint Medical Clinics. These adult day care clinics were designed to provide care and companionship for older adults in need of assistance or supervision during the day. But providing care to the elderly was not Nahas intention. Fraud was on his agenda.

Instead of caring for the vulnerable, Nahas would travel to his adult day care centers with the sole purpose of ordering unnecessary lab tests and prescriptions on behalf of his elderly clients who were spending time there. His medical assistant, Isabel Pruneda was also his fraud assistant. Pruneda forged the patient signatures on consent forms in order to process the unnecessary orders for payment. From January 2016 to December 2017, Nahas and Pruneda ordered unnecessary lab tests and prescriptions which resulted in millions in losses. They directed those prescriptions and tests to companies who then paid them in kickbacks.

Pruneda also misappropriated expensive patient medications to use in their scheme. For instance, she would strip patient information off the packaging of pain creams so that she could hand them out as “goodie bags” to incentivize patients to be tested. Now that is a swag bag! In June 2018, law enforcement executed a search warrant at Crosspoint and found hundreds of thousands in stolen medications.
In court Nahas’s and Pruneda’s partnership quickly unraveled. Nahas attempted to convince the jury the payments he received were legitimate “rent” payments for the use of space, and Pruneda ordered all the prescriptions and lab tests without his consent. Conversely, Pruneda’s defense argued she was doing what Nahas taught her and following orders, and she denied committing any forgeries. Luckily, the jury did not believe either and on March 3, 2024 found both guilty of Medicaid fraud.

Today’s Fraud of The Day is based on article “Texas doctor and clinic employee found guilty of healthcare fraud” published by My Texas Daily on March 3, 2024.

A federal jury has convicted a Texas doctor and a clinic employee on charges of healthcare fraud, conspiracy, and receiving illegal kickbacks. The verdict came after the pair ordered unnecessary lab tests and prescriptions, according to U.S. Attorney Alamdar S. Hamdani.

The jury found 69-year-old Dr. Osama Nahas, of McAllen, and 53-year-old Isabel Pruneda, of Edinburg, guilty of conspiracy to commit healthcare fraud, healthcare fraud, and conspiracy to violate the Anti-Kickback Statute after a two-week trial. Pruneda was also convicted of aggravated identity theft.

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