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TX CEO gets 15 years for healthcare fraud

The government continues its focus on aggressive prosecution of medical professionals who are accused of healthcare fraud. The government often uses multiple agencies to move forward with an investigation, often including use of the Health Care Fraud Strike Force, a specially trained group with 15 strike forces operating throughout the country.

A successful prosecution by these groups can lead to more than just a hefty fine. As highlighted in a recent case, these allegations can lead to prison times.

Details of the case

The case involves the CEO of a group of hospice and home-care centers throughout Texas. The United States Department of Justice (DOJ) presented evidence the CEO would tell patients that they only had six months to live as a result of a long-term incurable disease. As a result, he would provide them with allegedly unnecessary hospice services. Additional allegations include:

  • Falsification of medical records. In order to support the claim that these patients required hospice care, the prosecution states the accused would change the patients’ medical records to reflect the presence of an illness.
  • Illegal kickbacks. The DOJ also claimed the accused paid physicians to send patients to their facility. The government claims the CEO labeled these payments as medical director fees but that they were actually illegal bribes.

Overall, the government claims the accused filed these claims from 2009 through 2018 leading to over $150 million in fraudulent payments.

The jury reviews the evidence

When presented with the evidence, a jury convicted the accused of conspiracy to commit health care fraud, conspiracy to commit money laundering, obstruction of justice and six counts of health care fraud. These convictions led to a 15-year prison sentence.