Pharmacy Owner Pleads Guilty to $1.7 Million Health Insurance Scam
McALLEN, Texas ‐ A 45-year-old pharmacy owner has pleaded guilty to participating in a scheme to defraud Blue Cross Blue Shield of Texas, announced Acting U.S. Attorney Abe Martinez.
Omar Espericueta, of Palmhurst, pleaded guilty today, joining co-defendant Oscar Elizondo, 47, of Pharr, who pleaded guilty on Wednesday. Both men are accused of conspiring to submit over $1.7 million in fraudulent claims through Penitas Family Pharmacy, aka Riverside Pharmacy, to Blue Cross Blue Shield of Texas for expensive pain patches and scar creams.
Espericueta employed marketers, such as Elizondo, to target employees of entities throughout the Rio Grande Valley with health insurance through Blue Cross and other private insurance carriers. The marketers solicited employees with meals, drinks, and promises of “free” prescription pain patches and scar creams in order to obtain their health insurance information. The co-conspirators then used the insurance information, along with fraudulent prescriptions, to submit hundreds of fraudulent and medically unnecessary claims to Blue Cross.
Employees were never told that Espericueta’s Pharmacy planned to use their health insurance information to bill Blue Cross for several thousand dollars worth of prescriptions for each employee, many of whom stated they did not want or need the patches or creams. In many instances, Espericueta’s Pharmacy billed Blue Cross for prescriptions that were never delivered to employees, including multiple refills that were never requested.
Espericueta faces up to 10 years in federal prison and a $250,000 maximum fine. Sentencing has been set for Feb. 7, 2018, before U.S. District Judge Randy Crane. The FBI, Mission Police Department, Texas Department of Insurance – Fraud Unit, and Texas Health and Human Services Commission conducted the investigation. Assistant U.S. Attorney Andrew Swartz is prosecuting the case.
The guilty plea marks the latest development in an ongoing investigation into health insurance scams in the Rio Grande Valley. As our readers know, these types of scams often target vulnerable individuals and can have devastating consequences. We will continue to follow this story and provide updates as more information becomes available.
If you or someone you know has been a victim of a health insurance scam, please contact the Texas Department of Insurance – Fraud Unit at 1-800-621-0508 or visit their website at tdi.texas.gov.
Key Facts
- State: Texas
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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