Two San Antonians Sentenced to Prison for Health Care Fraud Schemes

SAN ANTONIO – This week, two San Antonio residents were sentenced for their roles in health care fraud schemes. Yesterday, Nancy Almaguer, 42, was sentenced to 18 months in prison and today Christopher Felix Montoya, 47, was sentenced to two 18-month prison sentences to run consecutively.

According to court documents, Montoya was a licensed physician’s assistant and owner of TPC Family Care and Medical Clinics in San Antonio and Laredo. Almaguer was the Chief Operating Officer for the clinics. Beginning in September 2018 through June 2019, Montoya and Almaguer agreed to refer lab testing requests to specific laboratories. The labs billed insurance programs, including Medicare and TRICARE, and paid Almaguer and Montoya a percentage of their receipts in return for the referrals. The kickback schemes resulted in over $500,000 in billings to public and private insurance companies.

In July and September of 2021, Montoya and Almaguer, respectively, pleaded guilty to one count of conspiracy to defraud the U.S. and to pay and receive health care kickbacks.

In a separate case, in July 2021, Montoya pleaded guilty to one count of conspiracy to receive health care kickbacks. In this case, Montoya admitted that for five months beginning in February 2015 he received kickbacks to write prescriptions for compounded medication from a California-based pharmacy that had high TRICARE reimbursements. Based on the evidence, TRICARE was billed $8,832,268.73 for prescriptions Montoya wrote to which TRICARE paid out $6,690,598.77.

In addition to the prison sentence, Almaguer was ordered to forfeit $137,792.10 in criminal proceeds and pay $52,603.62 in restitution. Montoya was ordered to pay a total of $849,865.93 in restitution.

“Kickback regulations exist to protect patient choice and ensure that only medically necessary procedures are performed,” said U.S. Attorney Ashley C. Hoff. “Our office continues to help protect federal insurance programs from fraud. We hope that these sentences communicate that these regulations should be taken seriously.”

“Health care fraud significantly harms the U.S. economy by costing this country billions of dollars a year,” said FBI Special Agent in Charge Christopher Combs. “Those losses result in rising medical costs for all Americans. The FBI is committed to investigating those involved in this crime through investigative partnerships with other federal agencies.”

The FBI; Texas Attorney General’s Office Medicaid Fraud Control Unit; U.S. Department of Health and Human Services—Office of Inspector General; the U.S. Office of Professional Management—Office of Inspector General; and the Defense Criminal Investigation Service investigated this case.

Assistant U.S. Attorneys Justin Chung and William R. Harris prosecuted this case on behalf of the government and Assistant U.S. Attorney Antonio Franco handled the forfeiture aspects.

Source: Two San Antonians Sentenced to Prison for Health Care Fraud Schemes / U.S. Department of Justice Western District of Texas

One Response

  • Nice to see these crooks caught. What is the percentage of money that is actually recovered. Most of these folks are going to be out of jail or never see the backside of metal bars anyway. Therefore did they actually win?

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