Danville, VIRGINIA – A Danville doctor, who billed various insurers for services he never administered to patients, even after he was warned about the practice, was sentenced today in the United States District Court for the Western District of Virginia in Danville on healthcare fraud and tax evasion charges, United States Attorney Rick A. Mountcastle announced.

Edwin L. Fuentes, 55, was sentenced today to 24 months in prison. Fuentes previously pleaded guilty to one count of healthcare fraud and one count of willfully evading taxes. The defendant was also ordered to pay $1,739,194. In addition, Fuentes was ordered to repay $125,789 in investigative costs.

"Fraud against healthcare benefit programs and the federal government must be severely punished,” United States Attorney Mountcastle said today. “I commend the Virginia Attorney General's Medicaid Fraud Control Unit, the Department of Health and Human Services Office of the Inspector General, the Internal Revenue Service-Criminal Investigations, the Danville Police Department, and the Virginia Department of Motor Vehicles-Law Enforcement Division for working together to bring the defendant to justice.”

 “Doctors who overcharge insurance plans for their services, place false notes in patient files, then hide the stolen money will be held responsible for their crimes,” said Special Agent in Charge Nick DiGiulio of the United States Department of Health and Human Services, Office of the Inspector General.  “We will continue to work with our law enforcement partners to bring justice to those who steal our health care dollars.” 

“Healthcare fraud hurts taxpayers and patients who rely on stable insurance programs, whether they are private plans, Medicare, or Medicaid,” said Attorney General Mark Herring. “I really appreciate the hard work and collaboration between local, state, and federal partners that has put an end to this significant fraud.”

“Mr. Fuentes chose to use the government healthcare programs as a personal piggy bank and today he is being held accountable,” said Kimberly A. Lappin, Special Agent in Charge of the IRS-Criminal Investigation, Washington D.C. Field Office. “Mr. Fuentes’ sentence serves as a reminder that IRS Criminal Investigation is committed to maintaining the integrity of our tax system and will continuously direct its efforts to those who willfully choose to evade their tax obligations.”

According to evidence presented at previous hearings by Assistant United States Attorney Heather L. Carlton, at trial the government’s evidence would have shown that as early as January 2012 and continuing through December 2014, Fuentes owned and operated Morning Star Family Medicine in Danville.  During this time, he knowingly and willfully executed a scheme to defraud a number of health care benefit programs, including Optima, Virginia Premier, Aetna, Anthem, Medicare, and Medicaid, by causing his medical practice to bill for services he did not provide.  Fuentes’ scheme included double-billing the same patient visits under two different billing codes and then attempting to conceal the scheme by falsifying notes in patient records.  As a result, the health care programs overpaid more than $990,000 to Fuentes and Morning Star.  In addition, Fuentes failed to report this income on his tax returns.

The investigation of the case was conducted by the Virginia Office of the Attorney General- Medicaid Fraud Control Unit, U.S. Department of Health and Human Services Office of the Inspector General and the Internal Revenue Service - Criminal Investigations. The Danville Police Department and the Virginia Department of Motor Vehicles-Law Enforcement Division provided assistance to the investigation. Assistant United States Attorney Heather L. Carlton and Special Assistant United States Attorney Kari Munro prosecuted the case for the United States.