Precarious Position

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East Texas is largely rural, and until one doctor opened six hospitals across that area of the state, residents did not have readily accessible emergency care. Initially, the hospital chain was a welcome addition, until accusations of fraud emerged. An article in The Dallas Morning News follows the investigation and conviction of the doctor who took advantage of his patients in order to submit more than $1.1 million in claims to Medicare.

At the doctor’s trial, the defense attorney stated that the Dallas businessman came to East Texas with the intent to help rural residents receive proper medical care. Unfortunately for his patients, the doctor used their personal medical information to bill Medicare for erroneous conditions that would generate larger reimbursements. (It sounds like the doctor set up shop in East Texas to help himself to government funds.)

As is often the case, fraudsters work with co-conspirators to help accomplish their crimes, and this story is no different. The doctor apparently had a habit of frequently visiting the offices of his billing coders. Witnesses testified that they were directed to change diagnostic codes to indicate more serious conditions. While some employees agreed to assist, one coder was fired three weeks after refusing to manipulate the codes. The defense attorney argued that the doctor merely made suggestions that the coders change the diagnoses to maximize hospital profits. (I’m sure it is purely coincidental that this coder lost his or her job.)

In less than two hours, a jury convicted the 63-year-old doctor on 15 counts of fraud, including identity theft. He is looking at 20 years or more in prison. He has agreed to pay back $312,886, the actual amount he illegally received from the false claims.

The investigation into the fraud allegations discovered that major regulatory gaps existed allowing the illegal coding and billing practices to continue. In addition, accusations of fraud by a former administrator went unaddressed. The article states that four out of the six hospitals have now closed and two are struggling to operate. Whether or not this doctor really intended to help the East Texas community by providing emergency healthcare, his selfish actions have sent Medicare beneficiaries back to where they started – in a precarious position without readily available emergency medical care.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Former Texas Hospital Chain Owner Found Guilty of Medicare Fraud,” written by Miles Moffeit and published by The Dallas Morning News on July 24, 2014.

TYLER — A federal jury took less than two hours on Thursday to find a Dallas businessman who plunged his rural hospital chain into ruin guilty of health-care fraud and conspiracy.

Dr. Tariq Mahmood, 63, was convicted on 15 fraud counts, including aggravated identity theft. Mahmood directed his hospital billing coders to illegally alter underlying diagnoses in more than $1.1 million in claims to the federal Medicare insurance program.

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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.