Death Sentence

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Partial hospitalization programs (PHPs) are structured mental health programs that provide outpatient services in lieu of inpatient psychiatric care. Medicare covers PHP services when provided through a hospital outpatient department or a community health center. In today’s ”Fraud of the Day,” a Federal Bureau of Investigation (FBI) press release details what happened to a former hospital assistant administrator who took advantage of his position and tried to steal more than $116 million from the government health care benefits program.

The story states that the former assistant administrator oversaw many of the PHPs at a Houston-area hospital. He accomplished his fraudulent scheme by paying kickbacks to his co-conspirators – patient recruiters as well as owners and operators of group homes – in exchange for ineligible Medicare beneficiaries. (The fraudster submitted claims for PHP services that were not medically necessary and usually not provided.)

The 65-year-old man pleaded guilty to conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and paying illegal kickbacks. He was sentenced to a hefty 40 years in prison and ordered to pay restitution of $31,321,200.

For more than four years, the fraudster also had help from nine co-conspirators including the hospital’s former president and his son, a patient file auditor, group home operators and patient recruiters. They have all pleaded guilty to their parts in the scheme.

Congratulations to the Medicare Fraud Strike Force for bringing down this heavy hitter and prosecuting to the full extent of the law. This fraudster has essentially received a death sentence and it looks like he will be spending his retirement years locked up behind bars. (Let’s hope this case serves as a deterrent to others who think they can get away with defrauding the government.)

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Assistant Administrator of Riverside General Hospital Sentenced to 40 Years in Prison in $116 Million Medicare Fraud Scheme,” released by The Federal Bureau of Investigation on May 21, 2015.

The former assistant administrator of Riverside General Hospital was sentenced today to 40 years in prison for his role in a $116 million Medicare fraud scheme. To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division and U.S. Attorney Kenneth Magidson of the Southern District of Texas made the announcement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.