In a decisive move against health care fraud, Texas Attorney General Ken Paxton's Medicaid Fraud Control Unit collaborated with federal agencies to put Houston dentist Rene Fernandez Gaviola behind bars for a $6.9 million scam. According to a release published by The Office of the Texas Attorney General, Gaviola faces a 60-month federal prison sentence and has been hit with nearly $5 million in restitution payments to Medicaid.
Perpetrating a scheme that involved kickbacks and falsified billing, Gaviola took advantage of a system entrusted to aid the most vulnerable. His elaborate fraud not only involved billing Medicaid for phantom services but also the utilization of unlicensed individuals to practice dentistry. In the statement released by the Texas Attorney General, Paxton condemned the fraud, saying, "Fraudulent schemes like the one perpetrated by Mr. Gaviola undermine our health care system and maliciously exploit funding that comes from hardworking taxpayers."
Alongside the sentence and restitution, Gaviola has been ordered to serve three years of supervised release and to pay a personal money judgment of $2,996,092. He pleaded guilty to multiple counts which include Conspiracy to Commit Health Care Fraud, Health Care Fraud, Conspiracy to Pay and Receive Health Care Kickbacks, Payment of Health Care Kickbacks, and Money Laundering. Gaviola's methods involved kickbacks to marketers in exchange for referrals of child Medicaid beneficiaries, followed by fraudulent Medicaid claims.
The takedown was a joint effort, with crucial support provided by the FBI and the Department of Health and Human Services’ Office of Inspector General. Charged with the investigation were Sergeant Alfred Paige, Investigative Auditor Mai Tang, and Captain Alex Chancia from AG Paxton’s Medicaid Fraud Control Unit. According to The Office of the Texas Attorney General, the team's efforts resulted not only in Gaviola's conviction but have also formed part of a greater endeavor that has recovered more than $612 million for Texas taxpayers since 2021.
Notable in its efficiency, the Medicaid Fraud Control Unit is heavily federally funded, receiving 75 percent of its resources from the U.S. Department of Health and Human Services. This translates into a grant award totaling $20,944,200 for the fiscal year 2023, with the State of Texas supplementing the remaining 25 percent at $6,981,395. With the restitution fines and judgments accrued over the last three years, the unit has managed to return more than 49 dollars for every state dollar invested—marking a significant return on investment in the fight against health care fraud.
