In The News

Houston-area Psychiatrist Sentenced to More than 12 Years for his part in a $155 Million Medicare Fraud Scheme

The government continues to dole out hefty fines and prison sentences to those who defraud its programs and the citizens they serve. This was demonstrated earlier this month when representatives from several agencies including the FBI, the U.S. Department of Health and Human Services-Office of Inspector General, the Internal Revenue Service, and others announced that a Houston-area psychiatrist has been convicted of participating in a $155 million scheme to defraud the Medicare program. The psychiatrist – Riyaz Mazcuri – was sentenced in the Southern District of Texas by U.S. District Judge Vanessa D. Gilmore. Mazcuri has been ordered by Judge Gilmore to pay $20,607,410.22 in restitution to Medicare and $2,250,789.69 in restitution to Medicaid. The formal charges against Mazcuri include conspiracy to commit health care fraud and health care fraud.

The evidence presented at trial showed that from 2006 until February 2012, Mazcuri and others engaged in a scheme to defraud Medicare by submitting false and fraudulent claims to Medicare costing the program $155 million. These claims were for its partial hospitalization program (PHP) services. PHP services are used to treat patients suffering from mental illness and substance abuse on an outpatient basis. That same evidence showed that Mazcuri and his confederates admitted patients into these intensive psychiatric programs when they did not qualify for participation in those programs by virtue of their incapacitation from Alzheimer’s and/or dementia. Evidence also showed that Mazcuri falsified records and signed documents to make it appear as if these patients did indeed qualify for participation in this program.

Mazcuri, the evidence further showed, billed Medicare for psychiatric treatments which he never provided. His signature on patient documents allowed Riverside General Hospital (Riverside) of Houston to bill Medicare for over $55 million of the total 155 million that it billed for psychiatric services. To date, 15 others have been convicted for their roles in this scheme to defraud Medicare and Medicaid. Several of the defendants have received prison sentences with one – Mohammad Khan – having received a sentence of 40 years in prison.

The convictions were made possible as a result of the ongoing efforts of the Medicare Fraud Strike Force. This is a joint initiative of the Department of Justice and HHS. The initiative seeks to prevent and deter fraud against Medicare, Medicaid and other government programs. The Strike Force operates in 10 areas across the country. Since its inception in March 2007 it has caused over 3,500 defendants to be charged with fraudulently billing Medicare and other programs and has recovered $12.5 billon. The government is often aided by citizens who report such incidences and are thus protected by whistleblower Medicare laws. People who do so are entitled to a share in the recovery the government makes in such cases and are able to retain a qui tam attorney in these efforts.