Former county commissioner sentenced to prison for health care fraud

McALLEN — A former Hidalgo County commissioner and his wife were sentenced Thursday to federal prison for defrauding government-funded health care programs through their ambulance business.

U.S. District Judge Ricardo Hinojosa ordered three years and five months of incarceration for Guadalupe Garces Jr., 52, and two years and nine months for Araceli Garces, 48.

Additionally, the couple will have to pay back nearly $637,000 of the $4.5 million they allegedly bilked from Medicare and Medicaid between 2001 and 2006.

A federal jury convicted the Garceses on multiple counts of conspiracy and health care fraud in 2008.

Throughout the trial, prosecutors alleged the couple’s A-Stat Ambulance company billed the health care programs in excess of $12 million for transporting dialysis patients to regular treatment sessions even though they could walk or be pushed in a wheelchair.

Medicare and Medicaid will only reimburse ambulance companies for driving bedridden patients to doctor’s visits.

To get around those restrictions, the Garceses advised their emergency medical technicians to alter ambulance run sheets and coached them on the language they should use so the company could later be reimbursed. The couple even offered pay incentives to those EMTs who brought in the most federal money for A-State, prosecutors said.

Even after federal agents began investigating their business, the couple found new ways to continue their fraudulent billing.

At one point, Guadalupe Garces allegedly told his EMTs that he knew investigators were following his ambulances and that drivers should pick patients up from inside their homes and drop them off inside the clinics so it appeared that they were bedridden.

When Medicare and Medicaid suspended all payments to A-Stat, the couple had their son launch a new ambulance business — A Care E.M.S. — and file for government health care reimbursements.

The former director of operations of that company pleaded guilty in 2007 to one conspiracy count and remains free on bond pending sentencing.

But the Garceses’ defense team maintained that each of the patients shuttled by both companies had certificates from doctors requiring ambulance trips out of medical necessity.

The attorneys produced such documentation for a few patients during the trial, and ultimately a jury acquitted the couple of all counts having to do with their time at A Care.

But while the judge said those certificates prevented him from considering those patients in his sentencing decision, he made it clear that he did not necessarily believe all of them actually needed transportation to and from their treatments.

Hinojosa allowed the Garceses to remain free on bond until they are required to report to the U.S. Bureau of Prisons later this year.

Guadalupe Garces, who represented McAllen, Edinburg and the northern parts of the county on the Commissioners Court, served from 1995 to 1999 as part of a panel led by then-County Judge J. Edgar Ruiz.

His attorney Ricardo Salinas did not return calls for comment Thursday.