Fuentes directed and ordered Morning Star employees, from at least January 2012 through December 2014, to bill various health care benefit programs for services he did not provide through a scheme to defraud those programs. Specifically, Fuentes would bill health care benefit programs for the patient visit under an “evaluation and management” code. In addition, Fuentes would bill the health care benefit program for “preventative counseling” sessions for the exact same patients visits, which would result, effectively, in double billing.
A few mistakes may have resulted in an overpayment demand or perhaps a hefty settlement. However, it appears the doctor shrugged off a series of audits that revealed the pattern of fraudulent billing.
After auditors discovered this fraud in 2012, 2013 and again in 2014, Fuentes attempted to conceal the fraud by making notes in patient records that some sort of counseling had been administered to patients. However, patients never received counseling.
That explains the fraud charge. The tax evasion charge shows how far investigators are will go to track funds earned through criminal activity.
During this time period, various health care benefit programs overpaid Fuentes, through Morning Star, $998,228. In addition, Fuentes diverted some of these funds to a Wells Fargo bank account. He used these funds for day trading, the profits of which he concealed from the Internal Revenue Service by not reporting it as income for the tax years of 2011 through 2014.