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HOUSTON, Texas (KTRK) — The manager and operator of a Houston-area dental clinic will spend time in federal prison for orchestrating a $6.8 million Medicaid fraud scheme. He’s also accused of allowing his unlicensed son to perform services on patients.
Rene Fernandez Gaviola, 68, pleaded guilty on Jan. 26 to the alleged scheme. Federal prosecutors said he operated three Floss Family Dental Care locations from 2018 until April 2021.
Those locations were at 3300 S. Gessner, 6121 Hillcroft, and 6929 Jensen.
According to court documents, Gaviola paid patient recruiters kickbacks for Medicaid client referrals. The recruiters, in turn, gave a portion of those kickbacks to the parents who brought their children to Floss for dental services.
The children were seen at Floss for exams and cleanings by various employees but rarely ever by their only licensed dentist. Gaviola would then submit fraudulent claims to Medicaid for pediatric dental services, including hundreds of cavity fillings that were never done.
He also reportedly illegally employed his son, who was not a licensed dentist, to provide services to Medicaid-insured children. Gaviola then billed Medicaid for the services under the licensed dentist’s name.
Between June 2019 and January 2021, Gaviola and his co-conspirators submitted approximately $6.8 million in claims to Medicaid and Dental Maintenance Organizations (DMO) for medical services purportedly performed by the licensed dentist.
Medicaid and the DMOs paid $4.9 million on those claims.
According to a release from the U.S. District Judge’s office, Gaviola also admitted to laundering Medicaid monies from the clinic’s bank account to his personal account in several transactions exceeding $100,000.
Gaviola was sentenced to 10 years in prison. In addition, a judge ordered him to pay $4,908,957.89 in restitution to Medicaid and a personal money judgment of $2,996,092.