Houston-Area Psychiatrist Convicted of Health Care Fraud for Role in $158 Million Medicare Fraud Scheme
A federal jury convicted a Houston-area psychiatrist today for his role in a $158 million Medicare fraud scheme.
Acting Assitant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge D. Richard Goss of Internal Revenue Service-Criminal Investigation’s (IRS-CI) Houston Field Office, Special Agent in Charge Kristin Osswald of the Railroad Retirement Board Office of Inspector General’s (RRB-OIG) Chicago Regional Office and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
After a five-day trial, Riaz Mazcuri, 65, of Harris County, Texas, was convicted of one count of conspiracy to commit health care fraud and five counts of health care fraud. Sentencing has been scheduled for Oct. 10, 2017, before U.S. District Judge Vanessa D. Gilmore of the Southern District of Texas, who presided over the trial.
According to evidence presented at trial, from 2006 until February 2012, Mazcuri and others engaged in a scheme to defraud Medicare by submitting to Medicare, through Riverside General Hospital (Riverside), approximately $158 million in false and fraudulent claims for partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness.
The evidence presented at trial showed that Mazcuri participated in a scheme by which Riverside paid bribes and kickbacks to group home owners and nursing home employees in exchange for sending Medicare patients to Riverside’s PHPs. Mazcuri indiscriminately admitted and readmitted these patients into these intensive psychiatric programs – often for years on end – many of whom suffered from severe Alzheimer’s or dementia and were unable to participate in the treatment purportedly provided at the PHPs, and who therefore did not qualify for the services, the evidence showed.
In addition, evidence presented at trial showed that Mazcuri rarely saw patients and that he visited the PHPs briefly every week or so to sign documents and briefly see patients. Additionally, Mazcuri falsified medical records and signed false documents purporting to show that patients admitted to the PHPs qualified and required the intensive psychiatric services, the evidence showed. Evidence also showed that Riverside did not actually provide the intensive, psychiatric treatment that a PHP is supposed to provide and falsified documentation to make it appear to Medicare that intensive treatment was being provided to qualifying patients.
Evidence at trial demonstrated that Mazcuri personally billed Medicare for over $4.5 million for psychiatric treatment he purportedly provided to Riverside’s PHP patients. Mazcuri’s signature on patient documents enabled Riverside to bill Medicare for $55 million of the total $158 million that Riverside billed Medicare for fraudulent psychiatric services, the evidence showed.
To date, 15 others have been convicted of offenses based on their roles in the fraudulent scheme. These include Earnest Gibson III, the former president of Riverside; Earnest Gibson IV, the operator of one of Riverside’s PHP satellite locations; Regina Askew, a group home owner and patient file auditor; and Robert Crane, a patient recruiter, all of whom were convicted after a jury trial in October 2014. Earnest Gibson III was sentenced to 45 years in prison. Earnest Gibson IV was sentenced to 20 years in prison. Regina Askew was sentenced to 12 years in prison. Robert Crane has not yet been sentenced. Mohammad Khan, an assistant administrator at the hospital, who managed many of the hospital’s PHPs, pleaded guilty and was sentenced to 40 years in prison. Sharon Iglehart, a physician, was also convicted after a jury trial in August 2015. She was sentenced to 12 years in prison. Walid Hamoudi, a physician, pleaded guilty in August 2015. He was sentenced to five years in prison.
The case was investigated by the FBI, HHS-OIG, IRS-CI RRB-OIG and the MFCU, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas. The case is being prosecuted by Assistant Chief Ashlee McFarlane and Trial Attorneys Kevin Lowell and Aleza Remis of the Fraud Section.
The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.