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Houston dental clinic operator convicted in $6M pediatric fraud scheme

HOUSTON – A 68-year-old man has pleaded guilty in a $6 million Medicaid fraud and kickback scheme, announced U.S. Attorney Alamdar S. Hamdani.

Rene Gaviola was the operator of Floss Family Dental Care clinic located in Houston. From 2018 until April 2021, Gaviola admitted to submitting fraudulent claims to Medicaid for pediatric dental services, including numerous cavity fillings, that Floss did not provide.

Gaviola admitted he employed one individual to practice dentistry without a license on Medicaid-insured children. He also operated Floss, on occasion, without any dentists at all. Floss billed Medicaid for these dental services as if licensed dentists provided them.

Gaviola also admitted to paying kickbacks to marketers and caregivers of Medicaid-insured children to bring them to Floss for dental services. Ultimately, he admitted to laundering Medicaid monies from the Floss business bank account to his personal bank account in several transactions exceeding $100,000.

From 2019 to 2021, the dental clinic billed Medicaid nearly $6.9 million in claims for pediatric dental services. Medicaid paid approximately $4.9 million on those claims.

“These precious Medicaid funds were intended to provide necessary dental services to low-income children in our community, not line Gaviola’s pockets,” said Hamdani. “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.”

“Gaviola took advantage of the system, and he took advantage of the children to defraud the system,” said Special Agent in Charge Douglas Williams of the FBI Houston field office. “Not only that, he also jeopardized the young patients’ healthcare by putting them in the hands of unlicensed practitioners, all in the name of his greed. 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 has set sentencing for April 16. At that time, Gaviola faces up to 10 years for conspiracy to commit health care fraud, each of five substantive health care fraud counts, three counts of payment of kickbacks and six counts of money laundering as well as five years for conspiracy to pay and receive kickbacks. The convictions also carry as possible punishment hundreds of thousands in potential fines.

Gaviola was permitted to remain on bond pending sentencing.

FBI, Texas Attorney General’s Medicaid Fraud Control Unit and the Department of Health and Human Services – Office of Inspector General conducted the investigation. Special Assistant U.S. Attorney Kathryn Olson and Assistant U.S. Attorney Lauren Valenti are prosecuting the case.