Physician assistant committed Medicaid fraud using retired doc's billing ID

Amid the brouhaha over whether nurse practitioners [1] should be allowed to practice without physician supervision, physician assistants (PA) still require MD oversight for all procedures. But in Alton, Texas, PA Manuel Anthony Puig and his wife managed to open and run La Hacienda Family Clinic, where he admitted to a judge on Friday that he racked up more than 6,000 Medicaid bills totaling $174,000, by forging and fraudulently processing the claims using a retired physician's provider number.

The now-deceased physician, who was not named in court filings, reportedly had never met Puig, much less discussed a business arrangement or agreed to supervise him, as the PA claimed to regulators when opening his clinic in 2005. According to prosecutors, the doctor retired in 2001 as a result of suffering from Alzheimer's disease.

The clinic owner, whose practice closed in 2007, also admitted during his July 23 hearing that between May 2005 and January 2006, his business sought compensation for services he was not licensed to perform, procedures that never took place and for medication that he and his wife later sold at a profit.

As a result, Puig faces up to 10 years in prison at sentencing hearing set for October. His wife, Romelia Sanchez Puig, a certified nursing assistant who allegedly acted as the biller for the clinic, has plead "not guilty" to charges for filing bills with Medicaid on her husband's behalf, and is set to take her case before a jury next month. The pair could be also forced to pay $250,000 restitution for the money they allegedly cheated out of the program.

To learn more:
- read this article [2] in the Monitor
- see this piece [3] on examiner.com

Related Articles:
Physician assistant, nurse practitioners roles blurring [4]
CMS now says NPI must match IRS data [5]
CMS to fight Medicare, Medicaid fraud with high tech 'bounty hunters' [6]