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Fraud is any deliberate act to take property or money by deception from a victim. In other words, it’s an intentional act to deceive for the purposes of unlawfully or unfairly gaining something. (It’s driven by a fraudster’s need to become wealthy without having to actually work hard for the money.) Today, we take a look at a case involving a Rio Grande City, Texas durable medical equipment business owner. He was very deliberate in carrying out a Medicaid fraud scam that allegedly involved falsely billing the Texas Medicaid program for more than $1 million.

The fraud article explains that the Texan business purportedly ran the Medicaid fraud scam for more than six-and-a-half years. There was no doubt that the owner of the durable equipment company located in Roma was intentional. (He deliberately destroyed patient records to conceal his false claims to Medicaid.) He supposedly created false documentation to back up the claims for his victims. Apparently, he is also in trouble for identity theft. He allegedly stole the names, medical license numbers and national provider identifier numbers from local physicians. (That’s how he was able to stick Medicaid with a $1 million bill.)

The 47-year-old man at the center of today’s Medicaid fraud article is charged with one count of conspiracy to submit false statements relating to healthcare matters; eight counts of false statements relating to health matters; and, five counts of aggravated identity theft. He could receive up to five years in federal prison plus a $250,000 possible fine for each healthcare matters charge, if convicted. An identity theft conviction would slap on an additional two years behind bars, which must be served consecutively to any other prison sentence he receives.

It’s important to remember that today’s Rio Grande City, Texas durable medical equipment business owner has not been convicted to date. (So, that means he is innocent until proven guilty.) But, in case prosecutors are successful, you can be sure that the government will be intentional about stopping others from committing the same type of fraud, thus the court will be deliberate in assigning an appropriate punishment.

Today’s “Fraud of the Day” is based on an article entitled, “RGC man, owner of medical equipment company indicted on fraud charges,” published by The Monitor on December 20, 2018.

A Rio Grande City man is scheduled to make his initial appearance in federal court Friday in connection with allegations that he fraudulently billed Texas Medicaid more than $1 million in claims, according to a news release.

The Southern District of Texas U.S. Attorney’s office said in a release that Omar Cuate Canales is scheduled for his initial hearing Friday in connection with a scheme that purportedly ran for more than six years.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.