June 12: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
$158M Medicare fraud scheme for healthcare services not rendered
Earnest Gibson III, former President of Riverside General Hospital, Earnest Gibson IV, Operator of Devotions Care Solutions, a satellite psychiatric facility of Riverside General Hospital, and Regina Askew, Owner of Safe and Sound group home, were sentenced this week to 45 years, 20 years, and 12 years in prison, respectively, for participating in a $158 million Medicare fraud scheme. Six other individuals have also pleaded guilty in this scheme, according to the Department of Justice.
The Gibsons and Askew saw mentally ill, elderly, and disabled Medicare beneficiaries “as commodities to be turned into profit centers,” says Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division. “Rather than providing needed medical care to a historically underserved community, the defendants ran a longstanding hospital into the ground through their greed and fraud,” Caldwell states.
Patients of the Gibsons and Askew watched films but received no medical treatment, according to evidence. Additionally, beneficiaries with Alzheimer’s could not actively participate in treatment billed to Medicare, confirms trial evidence. Nonetheless, Medicare was billed for $158 million for care never provided in what Caldwell refers to as “brazen fraud.” Restitution amounts ordered to be paid from the 3 defendants total nearly $100 million.
Georgia hospital faces lawsuit for referral kickbacks
A Georgia hospital, Clearview Regional Medical Center (Walton Regional Medical Center, now owned by Community Health Systems), is in hot water for paying kickbacks to clinics for the referrals of undocumented pregnant beneficiaries.
“Instead of providing health care services to expectant mothers in its area and receiving payment for those services from Medicaid, the hospital participated in a scheme to pay kickbacks in exchange for having pregnant women from outside its market funneled to its facility with the goal of increasing the amount of Medicaid money the hospital could claim,” claims Michael Moore, Attorney of the Middle District of Georgia.
The Clearview Regional Medical Center is now in the midst of a nearly $600,000 False Claims Act lawsuit with Health Management Associates (HMA). According to the lawsuit, the hospital paid kickbacks to an obstetric clinic serving undocumented Hispanic women in exchange for patient referrals for hospital delivery and labor. Medicaid was then billed for such services.
“Although undocumented aliens are not eligible for regular Medicaid coverage, the Medicaid program provides coverage for emergency conditions, including childbirth, for undocumented aliens,” confirms the Department of Justice’s press release.
Efforts are in place to ensure healthcare providers who pay kickbacks in return for patient referrals will be held responsible, states Principal Deputy Assistant Attorney General, Benjamin C. Mizer of the Justice Department’s Civil Division. “Schemes such as this one corrupt the health care system and take advantage of vulnerable patients,” he maintains.
HMA and Clearview will pay the state nearly $400,000 to settle Georgia’s claims under the Georgia False Medicaid Claims Act.
