Clinic Manager Heads to Prison for Health Care Fraud
HOUSTON – The 47-year-old owner and operator of Elite P. Care Medical Services has been sentenced for her role in a health care fraud conspiracy that billed Medicare and Medicaid for more than $1 million in fraudulent health care claims, announced U.S. Attorney Kenneth Magidson.
Verona Spicer, of Houston, pleaded guilty to conspiracy and health care fraud charges in October 2015. Today, she was ordered to federal prison for 33 months.
Spicer had clinics located on Harwin Drive in Houston and in Port Arthur. She submitted claims to Medicare and Medicaid that fraudulently billed for physician office visits not performed by a licensed physician, physical therapy services not provided or performed by a licensed physical therapist and medical diagnostic tests not ordered as medically necessary by a licensed physician.
Spicer paid Houston physician Dr. Jocelyn Pyles, 59, of Sugar Land, who formerly worked full-time as a physician for the City of Houston. After completing her work for the City of Houston, would go to Spicer’s clinics where she signed patient medical records for patients she had not seen or examined. Spicer and Pyles signed Medicare and Medicaid enrollment applications that enabled the fraudulent billing under Pyles’ Medicare and Medicaid provider numbers.
A foreign medical graduate who was not licensed to practice medicine in the United States was actually the person who saw the patients.
Pyles was also ordered to prison after a jury convicted her of 14 counts of health care fraud in November 2015.
Spicer and Pyles were both also ordered to pay Medicare and Medicaid $560,718.62 in restitution.
The Department of Health and Human Services – Office of Inspector General, FBI, Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation with assistance of Medicare Zone Program Integrity Contractor, Health Integrity LLC. Assistant U.S. Attorney Julie Redlinger prosecuted the case.