A reminder to check your Explanation of Benefits (EOB) statements from your health insurers to see if you spot any visits, appointments, or services that you never got but were billed for.
McALLEN, Texas – A 46-year-old resident of Mission has been taken into custody on charges of health care fraud and aggravated identity theft in connection with a scheme to defraud the Texas Medicaid Program, announced U.S. Attorney Alamdar S. Hamdani.
Juan Martin Flores, 46, is set to make his initial appearance before U.S. Magistrate Judge J. Scott Hacker at 9 a.m.
The indictment, returned Aug. 7 and unsealed upon his arrest Sept. 12, alleges he submitted or caused the submission of over 15,000 fraudulent claims to Medicaid for services that were never provided. Between 2018 and 2022, the claims resulted in approximately $2 million in Medicaid payments, according to the charges. The indictment further alleges Flores used the personal information of Medicaid beneficiaries without their consent to facilitate the fraudulent billing scheme.
According to the charges, Flores submitted claims under his national provider identifier number, representing that he provided counseling services at his office in Brownsville. However, he allegedly never actually rendered those services. The indictment details multiple instances in which he unlawfully used Medicaid beneficiaries’ identities in the fraudulent claims.
Flores is charged with 10 counts of health care fraud, each carrying a possible 10-year-maximum sentence and up to a $250,000 fine. He is also facing three counts of aggravated identity theft. If convicted, he faces a mandatory two years in federal prison which must be served consecutively to any other sentence imposed.
The FBI, Department of Health and Human Services – Office of Inspector General and Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation. Assistant U.S. Attorney Andrew R. Swartz and Eric D. Flores are prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.