A Texas man must serve 10 years probation and pay hundreds of thousands of dollars in restitution after fraudulently filing claims for medical tests he was not authorized to perform on workers allegedly including his mother.
Samuel Yosimar Garza of Katy pleaded guilty in Fort Bend County to first-degree felony theft. On June 28, Judge Tameika Carter of the 400th Judicial District Court sentenced Garza to 10 years of deferred adjudication, a $5,000 fine, and $410,124 in restitution--$250,000 of which Garza submitted. Garza also must write an apology letter.
An investigation by the Fraud Unit of the Texas Department of Insurance showed that Garza, who isn’t a doctor or medical professional, billed an insurance company as a medical provider.
According to the investigation, a Houston-area company initially asked the company administering its employee health insurance why the health plan’s costs had quickly increased.
TDI investigators found that a company set up by Garza submitted claims in connection with 12 to 14 employees, allegedly including Garza’s mother and another relative. The claims were for workers joining sleep studies or getting allergy testing or electromyography (EMG) tests. However, the tests weren’t ordered or provided by medical professionals.
When the insurance administrator asked Garza for medical records to verify the claims, Garza had none.
“We hope revealing these misdeeds discourages fraud,” said Christopher Davis, who heads TDI’s Fraud Unit. “Patients deserve to get care from legitimate providers.”
You can report suspected insurance fraud by calling 800-252-3439.