Omar Espericueta, Health Insurance Fraud, Texas 2017

McAllen, Texas - A pharmacy owner and his marketer have been indicted in connection with a scheme to defraud Blue Cross and Blue Shield of Texas, announced Acting United States Attorney Abe Martinez.

Omar Espericueta, 45, of Mission, and Oscar Elizondo, 47, of Pharr, are charged with conspiracy to commit health care fraud, seven counts of health care fraud and six counts of aggravated identity theft.

According to the indictment, the scheme involved submitting more than $1.7 million in fraudulent claims to Blue Cross and Blue Shield of Texas for expensive pain patches and scar creams.

The defendants allegedly targeted employers that carry employee health insurance through Blue Cross, such as the City of Mission, City of Pharr, Frontera Produce and Point Isabel Independent School District, among others.

Working with contacts at those entities, Elizondo and other marketers offered meals, drinks and promises of “free” prescription pain patches and scar creams to entice employees to turn over their insurance information, according to the indictment.

The insurance information and fraudulent prescriptions were then allegedly used to submit fraudulent and medically unnecessary claims to Blue Cross.

Conspiracy to commit health care fraud and health care fraud carry a maximum punishment of 10 years in federal prison and a possible $250,000 maximum fine upon conviction.

A convicted for aggravated identity theft carries a mandatory two-year additional prison term which must be served consecutively to any other prison sentence imposed.

Source: https://www.justice.gov/usao-sdtx/pr/rgv-pharmacy-owner-and-marketer-arrested-connection-health-insurance-fraud-scheme