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$158 Million Medicare Fraud Leads to Criminal Penalties & Restitution

A psychiatrist in Houston Texas faced criminal charges for her part in a role in a scheme to defraud Medicare. She has now been convicted of violating the law. She was convicted of one count of health care fraud, one count of conspiracy to commit health care fraud, and three counts of making false statements related to health care claims. Her conviction came after a jury heard evidence for seven days during a trial held in the Southern District of Texas. She was found guilty in September of 2015 but her sentence was not handed down until April 1. She was sentenced to 12 years imprisonment and was ordered to pay $6.4 million in restitution and forfeit an additional $6.4 million in improperly obtained payments.  medical-faculty-1530317

Law 360 reports that the psychiatrist was one of 13 people who was convicted for their crime involving a joint effort to obtain Medicare payments for services which were not ever performed.

Medicare is supposed to provide payments for elderly seniors who need health services as well as to provide health service for certain people who suffer from a disability. The program cannot afford to be paying out millions in improper payments to caregivers who do not actually provide services. The Medicare Fraud Strike Force, which operates in nine cities and which is aimed at fighting fraudulent claims, was a leader in the investigation into this scheme. In many cases, it is whistleblowers who bring fraud schemes to the attention of authorities. Both the Fraud Strike Force and laws rewarding whistleblowers for coming forward are aimed at stopping Medicare and Medicaid fraud in their tracks.

Medicare Fraud Scheme Has Serious Consequences

The psychiatrist who was sentenced this April was the 13th person convicted for their role in the Medicare fraud scheme that was being operated. The scheme involved falsifying records and making claims to Medicare alleging patients had received individual psychotherapy and other treatment.

The false claims to Medicare were submitted through Riverside General Hospital in Houston, and the claims asserted patients had received partial hospitalization program (PHP) services. PHP services are for people with an extreme mental illness. PHP services involve intensive psychiatric care.

Not only were false claims submitted to Medicare to seek payment for patients who had not undergone psychiatric care, but medical records of actual patients were actually falsified to make it look as if they had undergone treatment when they had not done so. Many of the patients who the Department of Justice reached out to indicated they had either not seen a psychiatrist at all, or that they had not received intensive psychiatric treatment.

Medicare fraud like this hurts everyone, from taxpayers to seniors who are depending upon Medicare to legitimate care providers. If you see something going wrong and suspect fraud is occurring, you should strongly consider making a Medicare whistleblower claim. You could help the government catch the next perpetrator of fraud and could be richly rewarded in the process.