DALLAS — Dr. Nicolas Alfonso Padron, 54, of Garland, Texas, was sentenced Monday morning by U.S. District Judge David C. Godbey to 57 months in federal prison and ordered to pay $9,484,111 in restitution to the Centers for Medicare and Medicaid Services (CMS).
Padron pleaded guilty in September 2013 to one count of conspiracy to commit health care fraud stemming from his role as medical director of a physician house-call company, A Medical House Calls (A Medical). Padron has been in custody since his arrest in June 2012. The announcement was made on Monday by U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Two co-defendants in the case, Lawrence Dale St. John, 67, and his son, Jeffrey Dale St. John, 42, both of Grand Prairie, Texas, were each convicted in October 2013 on one count of conspiracy to commit health care fraud and 13 counts of health care fraud related to their operation of A Medical, which they owned and operated. Each count carries a maximum statutory sentence of 10 years in federal prison and a $250,000 fine. Restitution could also be ordered. Both are in custody and sentencing hearings are scheduled for March 31.
Padron joined A Medical as its medical director in December 2009. A Medical, which was also known as A+ Medical House Calls and ANM Physician House Calls provided physician visits to Medicare beneficiaries in their homes, rather than at a doctor’s office. A Medical had locations in Mesquite, Texas; Dallas; and Carrollton, Texas. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient.
Once A Medical established a Medicare beneficiary for physician home-visit services, it would submit billing for fraudulent care plan oversight claims. The company did not provide primary care physician services to Medicare beneficiaries.
From May 2010 to January 2012, the defendants conspired together and with others to defraud the Medicare program. A Medical, at the direction of Lawrence and Jeffrey St. John, submitted claims to Medicare using Padron’s unique Medicare number with Padron’s permission, regardless of the claim’s merit. The defendants conspired together to bill Medicare for care plan oversight by Padron for numerous beneficiaries when Padron was out of town, including dates when he was out of the country and on a cruise.
In total, the defendants billed taxpayers for $1.4 million of services that were either not medically necessary or not rendered at all. Through the fraudulent certifications, Medicare was billed an additional $9.7 million by home health agencies.
In a separate case, Padron entered a guilty plea to one count of conspiracy to distribute a controlled substance stemming from his operation of Padron Wellness Clinic, a “pill-mill,” that he operated in Dallas. A sentencing date has not been set in this case.
The investigation was conducted by U.S. Department of Health and Human Services - Office of Inspector General, the FBI and the Medicaid Fraud Control Unit of the Office of the Attorney General of Texas. Assistant U.S. Attorneys Kate Pfeifle and J. Nicholas Bunch are in charge of the prosecution.