A Houston physician is facing a 12-count federal indictment after prosecutors accused him and others of billing a federal COVID-19 reimbursement program approximately $30 million for medical office visits that patients never received.
Dr. Joseph A. Montes, 66, owned and operated Joseph A. Montes MD & Associates, P.A. and Montes Medical PLLC. Prosecutors say he allowed co-conspirators to operate pop-up COVID-19 testing sites under his name while claims connected to those operations were submitted to the federal Health Resources and Services Administration.
Patients went to the temporary sites for nasal swab testing, but the indictment alleges that HRSA was billed for evaluation and management office visits that did not actually take place, according to the U.S. Attorney’s Office for the Southern District of Texas.
A federal grand jury returned the indictment Sept. 30. Montes made his initial appearance before U.S. Magistrate Judge Christina Bryan on Oct. 6 after being taken into custody.
Pop-Up COVID Testing Sites Allegedly Billed for Office Visits
Federal prosecutors allege that between 2020 and 2022, Montes allowed other people involved in the scheme to operate temporary COVID-19 testing locations under his name. Patients visited those sites for nasal swabs, while claims were allegedly submitted for office visits that had never been provided.
The reimbursement claims were submitted to HRSA’s COVID-19 Uninsured Program, which generally reimbursed eligible providers at Medicare rates for COVID-19 testing, treatment and vaccine administration for uninsured patients. Participating providers had to verify patients’ uninsured status, accept the program reimbursement as payment in full and agree not to balance bill patients.
One Day Produced More Than 9,000 Claims
The volume of claims attributed to Montes’s clinics is one of the central allegations in the federal case. Prosecutors say the clinics submitted more than 3,000 claims for evaluation and management services on approximately 29 separate dates.
On Dec. 1, 2021, the clinics allegedly submitted more than 9,000 claims in a single day. The U.S. Attorney’s Office calculated that volume as roughly one patient encounter every nine seconds continuously over a 24-hour period.
From 2020 through 2022, Montes and others allegedly billed HRSA approximately $30 million. The government paid approximately $20 million of those claims.
The indictment also alleges that Montes used proceeds from the scheme for expensive purchases at a luxury vehicle dealership and Tiffany & Co.
Montes Faces Conspiracy, Wire Fraud and Money Laundering Charges
The 12-count indictment charges Montes with conspiracy, wire fraud and money laundering offenses. The U.S. Attorney’s Office said a conviction on the conspiracy charge can carry up to five years in federal prison, while each wire-fraud count carries a maximum of 20 years and each money-laundering count carries a maximum of 10 years.
Montes also faces a possible fine of up to $250,000. The FBI Houston Field Office, the Department of Health and Human Services Office of Inspector General and the Texas Attorney General’s Medicaid Fraud Control Unit investigated the case, and Assistant U.S. Attorney Kathryn Olson is prosecuting it.
The indictment contains allegations rather than findings of guilt. Montes is presumed innocent unless proven guilty in court.