Dental clinic operator sentenced for role in $6M pediatric fraud scheme

A Houston man has been sentenced for his role in a $6 million Medicaid fraud and kickbacks scheme, according to a news release from the U.S. Attorney’s Office, Southern District of Texas. 

Rene Fernandez Gaviola, 68, pleaded guilty Jan. 26 and has been ordered to serve 120 months in federal prison. He was the operator of Floss Family Dental Care clinic in Houston and submitted fraudulent claims to Medicaid from 2018 to 2021 for pediatric dental services like cavity fillings which Floss did not provide or unlicensed individuals provided, according to the release.

Mr. Gaviola illegally employed his son, who was not a licensed dentist, to provide dental services to Medicaid-insured children and occasionally operated Floss without any licensed dentists present. He also paid kickbacks to marketers and caregivers of Medicaid-insured children to bring them to Floss, the release said, and laundered Medicaid funds from the Floss business bank account to his personal account. 

Over the course of two years, Floss billed Medicaid nearly $6.9 million in claims for pediatric dental services. Medicaid paid approximately $4.9 million on those claims.