In what has been laid bare as a predatory scheme, a physician and a medical assistant have been handed down severe prison sentences for their roles in orchestrating a multimillion-dollar healthcare fraud, swindling Medicare, and taking advantage of the vulnerable. The announcement came from U.S. Attorney Nicholas J. Ganjei, whereby after a jury trial, Dr. Osama Nahas, 70, of McAllen, and Isabel Pruneda, 54, of Edinburg, were convicted of conspiracy to commit healthcare fraud, healthcare fraud, and conspiracy to violate the Anti-Kickback Statute. Pruneda was also found guilty of aggravated identity theft.
According to a U.S. Department of Justice press release, Chief U.S. District Judge Randy Crane sentenced Nahas to a 120-month imprisonment, while Pruneda received 97 months behind bars. Both individuals, profiting from the unnecessary medical orders on elderly patients, are required to serve three years of supervised release following their sentences.
The court denounced Nahas and Pruneda as “predators,” exploiting elderly, disabled, and otherwise vulnerable patients from adult day care centers. During the trial, it detailed how Nahas, owning Crosspoint Medical Clinic in Edinburg, trekked to various adult day care facilities across the Rio Grande Valley, arranging superfluous lab tests and prescriptions. Pruneda, employed as a medical assistant at Crosspoint, assisted in such underhanded dealings, notably by forging signatures and misappropriating expensive medications.
Employing a deceptive tactic, Pruneda distributed medications stripped of patient information and packaging as “goodie bags” to inveigle clients into compliance with their scheme, an action resulting in millions of loss from January 2016 through December 2017. As the trial evidence cited, this physician and his aide directed these unnecessary treatments toward selected companies in return for kickbacks. Additionally, they paid bribes, masquerading as “rent” payments to adult day care owners for unfettered access to facilities ripe for exploitation, according to the same press release.
Law enforcement took action in June 2018, executing a search warrant at Crosspoint, which led to the seizure of hundreds of thousands of dollars in stolen medications. The adult day care predators, as the court aptly labeled Nahas and Pruneda, had received hefty kickbacks amounting to tens of thousands of dollars from January 2016 to December 2017, hiding these transactions as rental agreements. While Nahas is allowed to remain on bond until he voluntarily surrenders, Pruneda's fate remains sealed as she remains in custody pending transfer to a yet-undetermined Federal Bureau of Prisons facility.
The probe into this fraudulent activity was a concerted effort by multiple agencies, including the FBI, Department of Health and Human Services – Office of Inspector General, Texas Attorney General’s Medicaid Fraud Control Unit, and Texas Health and Human Services - OIG. The U.S. Attorney's Office prosecutors, Assistant U.S. Attorneys Andrew Swartz and Brad Gray, brought the case to a close, according to the U.S. Department of Justice.
