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Hospital Administrator Faces $116M Medicare Fraud Allegation

The Department of Justice, the Federal Bureau of Investigation and the Department of Health and Human Services issued a joint statement yesterday. The groups charged a Houston area hospital administrator with seven counts in connection with fraudulent Medicare billing at his facility. The charges were again the result of the ongoing Medicare Fraud Strike Force investigations that have been conducted all over the country.

In this case, the man is charged with five counts of paying or offering to pay healthcare kickbacks and one count each of conspiracy to commit healthcare fraud and conspiracy to pay and receive illegal healthcare kickbacks. The conduct in question involved recruiting Medicare eligible people to serve as patients for mental health treatments. The treatments were either never provided or were not appropriate for the patients being treated. To secure the cooperation of the patients, the many is alleged to have provided cash payments, cigarettes, food and other inducements. He is alleged to have paid some patients directly, while also paying recruiters with connections to group homes and assisted living facilities.

With an estimated $116 million in improper Medicare billing, the scheme was bound to draw the attention of federal prosecutors. An official at the Criminal Division of the Justice Department indicated that it is their intention to continue their aggressive pursuit of individuals suspected of Medicare fraud. The government has expended significant resources in investigating these claims and is eager to continue to highlight their successes in apprehending those connected with improper billing.

If convicted, the hospital administrator faces a lengthy prison sentence. Medicare fraud is a hot-button issue in the current political climate. Those in the medical field will likely continue to be subjected to intense scrutiny as the expense of the Medicare program grows.

Source: Fierce Healthcare, "Hospital exec arrested in $116M Medicare scheme," by Karen M. Cheung, 9 February 2012

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Hospital Administrator Faces $116M Medicare Fraud Allegation | Frank A. Rubino, Esq.