Houston Dental Clinic Operator Pleads Guilty to $6 Million Medicaid Fraud and Kickback Scheme
Rene Gaviola, 68, the operator of Floss Family Dental Care clinic, has pleaded guilty in a $6 million Medicaid fraud and kickback scheme, as announced by U.S. Attorney Alamdar S. Hamdani.
Gaviola admitted to submitting fraudulent claims to Medicaid for pediatric dental services, including numerous cavity fillings, that Floss did not provide. The scheme ran from 2018 until April 2021. Gaviola acknowledged employing an individual without a dental license to practice on Medicaid-insured children and operating Floss without licensed dentists at times. The clinic billed Medicaid for these services as if licensed dentists had provided them.
The operator also confessed to paying kickbacks to marketers and caregivers of Medicaid-insured children to bring them to Floss for dental services. Additionally, Gaviola admitted to laundering Medicaid funds from the Floss business account to his personal account in transactions exceeding $100,000.
Between 2019 and 2021, Floss Family Dental Care billed Medicaid nearly $6.9 million for pediatric dental services. Medicaid paid around $4.9 million on those claims.
“This conviction is a reminder to all who attempt to defraud our healthcare system that we are committed to stamping out fraud and protecting the integrity of Medicaid and other federal programs,” said U.S. Attorney Hamdani.
Special Agent in Charge Douglas Williams of the FBI Houston field office stated, “Gaviola took advantage of the system, and he took advantage of the children to defraud the system. This case is a perfect example that healthcare fraud is not a victimless crime, and the FBI will continue to follow and uncover the fraud.”
Chief U.S. District Judge Randy Crane accepted the guilty plea and scheduled sentencing for April 16. Gaviola could face up to 10 years for conspiracy to commit health care fraud, five substantive health care fraud counts, three counts of payment of kickbacks, and six counts of money laundering. Conspiracy to pay and receive kickbacks carries a potential five-year sentence. The convictions may also result in hundreds of thousands of dollars in fines.
The FBI, Texas Attorney General’s Medicaid Fraud Control Unit, and the Department of Health and Human Services – Office of Inspector General conducted the investigation. Gaviola remains on bond until sentencing.
