Houston dental clinic operator heads to prison for role in $6M pediatric fraud scheme

HOUSTON - A 68-year-old man has been sentenced for orchestrating a $6 million Medicaid fraud and kickbacks scheme, announced U.S. Attorney Alamdar S. Hamdani.

Rene Fernandez Gaviola pleaded guilty Jan. 26.

Chief U.S. District Judge Randy Crane has now ordered Gaviola to serve 120 months in federal prison to be immediately followed by three years of supervised release. In addition, Judge Crane ordered Gaviola to pay $4,908,957.89 in restitution to Medicaid and a personal money judgement of $2,996,092. In handing down the sentence, the court noted Gaviola involved his own son in his “crooked” fraud scheme. Judge Crane also emphasized that Gaviola had failed to make any attempt to pay back restitution even though he has $2 million in assets stashed away in the Philippines.

Gaviola was the operator of Floss Family Dental Care clinic in Houston. From 2018 until April 2021, Gaviola submitted fraudulent claims to Medicaid for pediatric dental services, including numerous cavity fillings which Floss did not provide or unlicensed individuals provided.

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. Floss then fraudulently billed Medicaid for these services.

Gaviola also paid 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.

Gaviola’s co-conspirator, Mia Diaz, 48, Cleveland, a manager at Floss, was previously sentenced to 21 months imprisonment followed by three years of supervised release April 16.

Previously released on bond, Gaviola was taken into custody following the sentencing where he will remain pending transfer to a U.S. Bureau of Prisons facility to be determined in the near future.

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