Manager of Hospice and Home Health Companies Sentenced to Prison for Role in $150 Million Health Care Fraud Scheme | OPA

A Texas man was sentenced today to 27 months in prison for his role in a conspiracy at the Merida Group, a chain of hospice and home health agencies throughout Texas, to falsely convince thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified, thereby increasing revenue to the company. 

According to court documents, Jose Garza, 44, of Harlingen, was the operations manager for the Merida Group and responsible for carrying out the business’s day to day operations, including overseeing the recruitment of patients at certain locations throughout the Rio Grande Valley. Garza, and others working at his direction, recruited patients at hospitals and other medical practices by touting that the Merida Group offered “hospice that you don’t have to die to use,” pursuant to the Merida Group’s corporate marketing strategy.

At the trial of co-defendants Rodney Mesquias and Henry McInnis, witnesses testified that from 2009 to 2018, the vast majority of hospice and home health patients at the Merida Group did not qualify for services. Rather, physicians were bribed with illegal kickbacks, under the pretense of medical directorships, to falsely certify unqualified patients for services. Employees were instructed to falsify medical records, making non-terminal patients appear to be terminally ill and declining. Garza admitted to participating in the scheme, facilitating kickback payments to physicians, and directing employees to falsify medical records.

Garza pleaded guilty to one count of conspiracy to commit health care fraud on Sept. 9, 2019. Garza was charged along with three others who were convicted by a federal jury in Brownsville, Texas, in one of the largest criminal hospice fraud cases tried to a jury. Mesquias, 50, the owner of the Merida Group, was sentenced to 20 years in prison in December 2020. McInnis, 50, the CEO of the Merida Group, was sentenced to 15 years in prison in February 2020.

In addition to the prison sentence, Garza was ordered to pay $4,700,000 in restitution.

Acting Assistant Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division; Acting U.S. Attorney Jennifer Lowery of the Southern District of Texas; said Special Agent in Charge Christopher Combs of the FBI’s San Antonio Field Office made the announcement.

The Department of Health and Human Service – Office of Inspector General (HHS-OIG); FBI and Texas Health and Human Services Commission conducted the investigation.

Assistant Chief Jacob Foster and Trial Attorney Kevin Lowell of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Andrew Swartz of the Southern District of Texas are prosecuting the case. 

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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Author: Editor
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