SAN ANTONIO (KTSA News) — Two San Antonians were sentenced this week for their roles in health care fraud schemes.
Nancy Almaguer, 42, and Christopher Felix Montoya, 47, are accused of accepting kickbacks for referring lab testing requests to specific laboratories to the tune of $500,000 in billings to private and public insurance companies from September 2018 to June 2019.
Montoya was a licensed physician’s assistant and owner of TPC Family Care and Medical Clinics in San Antonio and Laredo and Almaguer was the Chief Operating Officer for the clinics.
In a separate case, Montoya is accused of accepting kickbacks starting in February 2015 for writing prescriptions from a pharmacy that had high TRICARE reimbursements. Officials said that TRICARE was billed $8,832,268.73 and paid out $6,690,598.77.
“Kickback regulations exist to protect patient choice and ensure that only medically necessary procedures are performed,” said U.S. Attorney Ashley C. Hoff. “Our office continues to help protect federal insurance programs from fraud. We hope that these sentences communicate that these regulations should be taken seriously.”
Almaguer was sentenced to 18 months in prison, was ordered to forfeit $137,792.10 in criminal proceeds and pay $52,603.62 in restitution.
Montoya was sentenced to two 18-month prison sentences to run consecutively and ordered to pay a total of $849,865.93 in restitution.
“Health care fraud significantly harms the U.S. economy by costing this country billions of dollars a year,” said FBI Special Agent in Charge Christopher Combs. “Those losses result in rising medical costs for all Americans. The FBI is committed to investigating those involved in this crime through investigative partnerships with other federal agencies.”
The FBI, Texas Attorney General’s Office Medicaid Fraud Control Unit, U.S. Department of Health and Human Services in the Office of Inspector General, the U.S. Office of Professional Management in the Office of Inspector General and the Defense Criminal Investigation Service investigated this case.