Medicare Compliance & Reimbursement

Pharmacist works with feds to catch co-conspirators.

Phony prescriptions that fraud scheme participants used to defraud Medicaid could net them lifetime imprisonment terms.

Felix G. Maldonado, owner of Maldonado Pharmacy in Brownsville, TX, conspired with at least two other individuals in an alleged Medicaid fraud scam, but now he's cooperating with prosecutors, state attorney general Greg Abbott announced Oct. 19. Maldonado won't face an indictment in return for his cooperation and his $465,000 repayment to the Medicaid program.

Authorities arrested Maldonado's co-conspirators, Juana Garcia and Hermelinda Altamirano, on Oct. 18, following their indictments on charges that include first-degree insurance fraud, felony theft and engaging in organized criminal activity. From 1998 to 2005, the crime ring purportedly billed Medicaid $536,000 using stolen Medicaid beneficiary numbers, and forged and phoned-in prescriptions.

The scam: "Altamirano, a nurse, wrote prescriptions and got the unwitting physician for whom she worked to sign them, then sold these to the third suspect," Abbott's office says. The third suspect--an X-ray technician who allegedly collected the phony prescriptions and gave them to Maldonado--is still at-large. The pharmacist and the X-ray technician shared the proceeds from Medicaid's payments for the prescriptions.

Altamirano faces two to ten years in prison and a $10,000 fine. Garcia and the fugitive suspect could face 99 years or life in prison and a $10,000 fine each.