In The News

Psychiatrist Convicted for his part in $158 Million Medicare Fraud Scheme

Sometimes convictions for violations of the False Claims Act can result in more than just corporate integrity agreements (CIA) and fines. They can sometimes result in prison terms for the accused. Case in point: Earlier this week, the Justice Department announced the conviction of a Houston-area psychiatrist for his role in a $158 million Medicare fraud scheme. The Justice Department worked with several agencies including the IRS and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU). Riaz Mazcuri, of Harris County Texas, was convicted of one count of conspiracy to commit health care fraud and five counts of health care fraud. Sentencing is to take place on Oct. 10, 2017 before a US District Judge in the Southern District of Texas. According to the government, from 2006 – 2012, Mazcuri and others defrauded Medicare by submitting false claims through Riverside General Hospital totaling $158 million. The claims submitted were for partial hospitalization program (PHP) services. (A PHP is a kind of intensive outpatient treatment for severe mental illness.)

The evidence presented at trial showed that Mazcuri participated in a scheme whereby Riverside paid bribes and kickbacks to group home owners and nursing home employees in exchange for sending Medicare patients to Riverside’s PHPs. Moreover, evidence showed that Mazcuri admitted and readmitted patients suffering from intense dementia and other mental illnesses into intensive psychiatric programs for years. Many of these patients did not qualify for the services that were purportedly provided at the PHPs. Mazcuri signed documents that allowed Riverside to bill Medicare $55 million of the $158 million that it billed Medicare for fraudulent psychiatric services.

To date, 15 others have been convicted for their participation in this scheme. Of those who have been convicted are Earnest Gibson III, the former president of Riverside and the operator of one of Riverside’s PHP satellite locations. The sentences of the convicted conspirators range from 5 to 45 years in prison. The case is being prosecuted by the Fraud Section of the U.S. Attorney’s Office for the Southern District of Texas. The investigation was conducted by several agencies including the FBI, HHS-OIG, IRS-CI RRB-OIG and the MFCU. Since its inception in March 2007, the Medicare Fraud Strike Force has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. If you have been accused of violating The False Claims Act it is advised that you contact a qui tam Medicare lawyer. Qui tam law firms will be able to advise you on such matters and protect your rights. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).