San Antonio businessman sentenced to federal prison in health care fraud scheme, DOJ says

Rafael Enrique Rodriguez, 49, ordered to pay over $6 million in restitution

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SAN ANTONIO – A San Antonio businessman was sentenced Monday to seven years in federal prison for his role in a multimillion-dollar health care fraud scheme, according to the Department of Justice.

Officials said evidence during a trial revealed that between Oct. 22, 2012, and Dec. 14, 2016, Rafael Enrique Rodriguez, 49, devised a scheme to defraud the Federal Employees Compensation Act, Office of Workers Compensation Program, a federal health care benefit program designed to provide workers compensation services to federal employees.

DOJ officials said Rodriguez billed the program for physical therapy and treatment using codes that a qualified professional provided when, in reality, unlicensed technicians were providing the services.

Rodriguez, the DOJ said, also used the identity of another person — a licensed physical therapist — to gain provider registration with the program without that therapist’s permission.

Officials said Rodriguez billed the program more than $7.5 million for the services and was paid more than $6 million for the fraudulently billed services.

“The sentence imposed in this case reflects our commitment to stamping out health care fraud,” U.S. attorney John F. Bash said. “This is not just a law-and-order issue. It’s also about making sure that Texans in need of medical treatment or other health care services can be confident that they are being told the truth about their care.”

Rodriguez was convicted on June 21 on six counts of health care fraud, five counts of wire fraud and one count of aggravated identity theft.

Rodriguez was ordered to pay $6,032,126.69 in restitution to the government and to be placed on supervised release for three years following completion of his prison term.

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