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Danville doctor sentenced to 2 years on healthcare fraud, ordered to pay $1.7 million

Morning Star Family Medicine in Danville (Google Maps)

DANVILLE, Va. (WSET) -- A Danville doctor, who prosecutors said billed various insurers for services he never administered to patients, even after he was warned about the practice, was sentenced on healthcare fraud and tax evasion charges.

The U.S. Attorney announced Edwin L. Fuentes, 55, was sentenced to 24 months in prison.

Fuentes previously pleaded guilty to one count of healthcare fraud and one count of willfully evading taxes.

He was also ordered to pay $1,739,194 in addition to repaying $125,789 in investigative costs.

"Fraud against healthcare benefit programs and the federal government must be severely punished,” United States Attorney Mountcastle said. “I commend the Virginia Attorney General's Medicaid Fraud Control Unit, the Department of Health and Human Services Office of the Inspector General, the Internal Revenue Service-Criminal Investigations, the Danville Police Department, and the Virginia Department of Motor Vehicles-Law Enforcement Division for working together to bring the defendant to justice.”

According to evidence presented at his previous hearings, the government's evidence would have shown that as early as January 2012 and continuing through December 2014, Fuentes owned and operated Morning Star Family Medicine in Danville.

During this time he knowingly and willfully executed a scheme to defraud a number of health care benefit programs, including Optima, Virginia Premier, Aetna, Anthem, Medicare, and Medicaid by causing his medical practice to bill for services he did not provide.

Fuentes' scheme including doublebilling the same patient visits under two different billing codes and then attempting to conceal the scene by falsifying notes in patient records, prosecutors said.

As a result, the health care programs overpaid more than $990,000 to Fuentes and Morning Star.

In addition, prosecutors said Fuentes failed to report this income on his tax returns.

The investigation of the case was conducted by the Virginia Office of the Attorney General-Medicaid Fraud Control Unit, U.S. Department of Health and Human Services Office of the Inspector General and the Internal Revenue Service - Criminal Investigations. The Danville Police Department and the Virginia Department of Motor Vehicles-Law Enforcement Division provided assistance to the investigation. Assistant United States Attorney Heather L. Carlton and Special Assistant United States Attorney Kari Munro prosecuted the case for the United States.

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