Category Archives: Health Care Fraud

Pain Management Group Agrees To Pay $312,000 To Resolve False Claims Act And Overpayment Allegations

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Monday, July 24, 2017

Pain Management Group P.C. (“PMG”), based in Antioch, Tenn., has agreed to pay $312,000 to settle federal and state False Claims Act and overpayment allegations, announced Jack Smith, Acting United States Attorney for the Middle District of Tennessee.

The settlement resolves allegations that PMG caused the submission of false claims to Medicare and TennCare for medically unnecessary urine drug tests. The settlement also resolves allegations that PMG caused the submission of false claims to Medicare and TennCare for non-Food & Drug Administration (“FDA”) approved pharmaceuticals Botox, Supartz, and Eufflexa, which PMG purchased from foreign-based suppliers. The United States contends that PMG administered the non-FDA approved pharmaceuticals to Medicare and TennCare patients and then billed Medicare and TennCare for the pharmaceuticals.

The United States’ investigation was initiated after extensive data analysis identified PMG as a potential outlier in the provision of urine drug testing to Medicare patients. Over the course of the investigation, the United States discovered information regarding PMG’s administration of non-FDA approved drugs to Medicare and TennCare patients. Once informed of the investigation, PMG cooperated and instituted remedial measures to address the United States’ allegations. The alleged conduct occurred during 2014-2015.

This matter was investigated by U.S. Department of Health and Human Services-Office of Inspector General and the Tennessee Bureau of Investigation. Assistant U.S. Attorney Jason Ehrlinspiel represented the United States.

The claims settled by this agreement are allegations only, and there has been no determination of liability.

Three Sentenced for Roles in Healthcare Conspiracy

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Thursday, July 13, 2017

Deborah Branch, Bryan Harr, Melissa Harr Will All Serve Time in Federal Prison

Abingdon, VIRGINIA – Three Bristol, Virginia residents, who were previously convicted of healthcare fraud, were sentenced today in Federal Court, Acting United States Attorney Rick A. Mountcastle, Virginia Attorney General Mark R. Herring and Nick DiGiulio, Special Agent in Charge, Philadelphia Regional Office for U.S. Health and Human Services – Office of Inspector General announced.

Deborah Branch, 65, was sentenced today to 72 months in federal prison. In a pair of separate hearings today, Bryan Harr, 41, was sentenced to 48 months in federal prison and Melissa Harr, 49, was sentenced to 48 months in federal prison. The three previously pled guilty to federal healthcare conspiracy charges. Branch additionally pled guilty to wire fraud.

“This case shows that fraud committed against our federal and state health care benefit programs is more than just simple theft of government money, there is a sinister side to the greed that fuels the criminal acts of defendants like these,” Acting United States Attorney Mountcastle said today. “This type of greed brings physical and emotional devastation upon the innocent, vulnerable victims for whom essential services are denied, simply to satiate the greed of these defendants. In this case, children were forced to live in filth in a room without electricity. The United States Attorney’s Office, and our partners at the Virginia Attorney General’s Office, Health and Human Services and others, will continue to aggressively pursue fraudsters, like Branch and the Harrs, whose criminal actions bring harm to vulnerable victims.”

“Anyone who diverts public funds for their private benefit is stealing from all of us and undermining an important system that provides thousands of Virginians with needed medical services,” said Attorney General Mark Herring. “A situation where people steal that money at the expense of their own disabled child is even more horrifying and unacceptable, and I’m glad to see these criminals brought to justice today. My award-winning Medicaid Fraud Unit and I will be relentless in holding accountable those who try to take advantage of our health care system.”

“It is shocking to imagine parents who would for many years neglect their disabled child and allow him to suffer horribly while they worked to steal taxpayer money meant to pay for the child’s much needed care,” said Special Agent in Charge Nick DiGiulio of the United States Department of Health and Human Services, Office of Inspector General. “We are satisfied that justice was served today, and we will continue to work with our law enforcement partners to jail heartless criminals who prey on beneficiaries and our health care system.”

According to evidence presented at previous hearings, Bryan Harr Sr. and his wife, Melissa Harr, hired Branch to work with one of their children, who suffers from intellectual and physical disabilities and who qualifies for services paid for by Virginia Medicaid, including personal assistance, respite and residential support services. These services are available to qualified individuals pursuant to Virginia Medicaid’s Intellectual Disability (ID) waiver program. The ID waiver program is designed to provide critical services that enable a recipient to remain at home instead of being placed in an institution. Recipients or their guardians are permitted to hire workers of their own choosing to provide these services, which are paid for by Virginia Medicaid. Branch was paid through two different Virginia Medicaid contractors: Public Partnerships, LLC and ResCare (formerly known as Creative Family Solutions).

From January 2010 until September 2015, Branch, with the knowledge of Melissa Harr and Bryan Harr Sr., submitted time sheets claiming Branch was providing services for Harr’s disabled son when she was not. In exchange for assisting Branch in being paid for work she did not do, Branch paid the Harrs approximately $200 every two weeks. Virginia Medicaid’s Department of Medical Assistance Services (DMAS) paid out $350,641.02 to the contractors based on these time sheets, of which $207,854.43 was paid to Branch. More importantly, the Harr’s disabled son did not receive the services he legitimately needed pursuant to the ID waiver program.

The investigation of the case was conducted by the Medicaid Fraud Control Unit of the Virginia Attorney General’s Office, the U.S. Department of Health and Human Services Office of Inspector General, and the Bristol Virginia Police Department. Special Assistant United States Attorney Janine M. Myatt, a Virginia Assistant Attorney General, prosecuted the case for the United States.

Owner Of Tampa Parathyroid Practice Agrees To Pay $4 Million To Resolve False Claims Act Allegations

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Monday, July 24, 2017

Tampa, FL  – Dr. James Norman, the owner and operator of James Norman, MD, PA, a/k/a James Norman, MD, PA Parathyroid Center, d/b/a Norman Parathyroid Center (collectively, Norman) has agreed to pay $4 million to resolve allegations that he violated the False Claims Act by knowingly engaging in various unlawful billing practices with respect to Medicare and other federal health care programs and their beneficiaries.

Specifically, the government alleges that, from April 2008 through December 2016, Dr. Norman submitted fraudulent claims to Medicare, TRICARE, and the Federal Employee Health Benefits Program for pre-operative examinations performed on the day before or the day of surgery, and charged and collected extra fees from federal health care beneficiaries for services for which he had already received payment from the government. These extra fees ranged from $150 to $750 for Florida residents, to $1,750 or more for patients who lived out-of-state. Collectively, Dr. Norman and his practice pocketed hundreds of thousands of dollars as a result of these illicit billing practices.

“Fraudulent billing of the government, while also charging Medicare and other federal health care beneficiaries extra fees for services that the government has already paid for victimizes taxpayers, military veterans, the elderly, and other members of our community, and will not be tolerated,” said Acting U.S. Attorney Muldrow. “This lawsuit and today’s settlement demonstrates our office’s ongoing efforts to safeguard federal health care program beneficiaries from the effects of such illegal conduct.”

In addition to paying $4 million, Norman has also agreed to enter into an integrity agreement with the Inspector General of the U.S. Department of Health and Human Services.

“Physicians who systematically overbill Federal health care programs and their vulnerable patients will be held responsible for this fraudulent behavior,” said Special Agent in Charge Shimon R. Richmond of HHS-OIG. “Those who engage in such schemes can expect a thorough investigation and strong remedial measures such as those in the Integrity Agreement we signed with Dr. Norman.”

The settlement concludes a lawsuit originally filed by a former patient of Dr. Norman, Myra Gross, and her husband, Dr. David Gross, in the United States District Court for the Middle District of Florida. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. Act also allows the government to intervene and take over the action, as it did in this case. Ms. Gross and her husband, Dr. Gross, will receive roughly $600,000 of the proceeds from the settlement with Norman.

The government’s action in this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida and the U.S. Department of Health and Human Services – Office of Inspector General. It was handled Assistant U.S. Attorney Christopher Tuite.

The case is captioned United States ex rel. Gross, et al. v. James Norman, MD, PA, et al., Case No. 8:14-cv-978-T-33EAJ. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Houston Physician Convicted of Conspiracy in $1.5 Million Medicare Fraud Scheme

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Friday, July 21, 2017

A federal jury convicted a Houston physician today for his role in a scheme involving approximately $1.5 million in fraudulent Medicare claims for home health care services and various medical testing and services.

Acting Assistant 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 and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

After a four-day trial, Ronald F. Kahn, M.D., 62, of Harris County, Texas, was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal kickbacks. Sentencing has been scheduled for September 25, before U.S. District Judge Kenneth M. Hoyt, who presided over the trial.

According to evidence presented at trial, from approximately 2006 until 2013, Kahn and others engaged in a scheme to defraud Medicare out of approximately $1.5 million in fraudulent claims for home heath care services in connection with Allied Covenant Home Health, Inc., a Houston home healthcare agency (Allied).  Kahn fraudulently admitted patients for home health care with Allied when they did not qualify for such services, the evidence showed. To make it appear that these patients did qualify, Kahn falsified medical records and signed false documents purporting to show that patients admitted to Allied’s home health program satisfied Medicare’s requirements for admission, the evidence showed.

The evidence also showed that Kahn paid illegal kickbacks for patients from Harris Health Care Group, a Houston medical clinic (Harris). Kahn paid illegal kickbacks to the owner of Harris in order to bill Medicare for facet injections that were medically unnecessary, not provided or both, the evidence showed.

The case was investigated by the FBI, HHS-OIG and Texas 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 Attorney Scott Armstrong of the Fraud Section.

The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in nine locations nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

Baton Rouge Home Health Company Settles False Claims Act Case For $1.7 Million

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Friday, July 21, 2017

BATON ROUGE, LA – Acting United States Attorney Corey R. Amundson announced that CHARTER HOME HEALTH, a Baton Rouge-based healthcare company, has agreed to settle a civil fraud complaint filed under the federal False Claims Act by paying the United States $1.7 million and entering into a Corporate Integrity Agreement.

The settlement arises from an investigation into allegations that Charter Home Health, through its officers, paid Veronica Green and others for patient referrals from 2006 through 2012, in violation of Medicare’s Anti-Kickback provisions. The settlement resolves the matter as to Charter Home Health and its officers, Wandell Rogers and Allison Williams.

As part of the settlement, Charter Home Health has agreed to enter into a Corporate Integrity Agreement (CIA). The CIA promotes compliance with the statutes, regulations, program requirements, and written directives of Medicare and all other federal health care programs, specifically dealing with, among other things, proper billing and submission of reimbursement claims by Charter Home Health.

The investigation leading to this settlement also resulted in Veronica Green’ s conviction for Social Security benefits fraud in the Middle District of Louisiana. Green had fraudulently concealed her receipt of the Charter referral payments from the Social Security Administration in order to continue receiving Social Security disability income. As a result, Green received $152,627 in social security benefits to which she otherwise would not have been eligible.

Acting U.S. Attorney Amundson stated, “We will continue to use all civil and criminal tools at our disposal to protect our tax dollars. I appreciate the hard work of the attorneys and investigators who handled this important matter on behalf of the United States. This settlement rightly results in the return of money to the federal government, along with a Corporate Integrity Agreement to help prevent any future improprieties.”

“Home health care providers who pay kickbacks in exchange for patient referrals will be held responsible at the settlement table. We will continue to crack down on such illegal, wasteful business kickback arrangements, which undermine medical judgement, corrode the public’s trust in the health care system, and divert scarce Medicare funding,” said Special Agent-in-Charge C.J. Porter, U.S. Department of Health and Human Services Office of Inspector General.

This matter was handled by the United States Attorney’s Office for the Middle District of Louisiana, through Assistant United States Attorney Catherine Maraist; the Dallas Regional Office of the United States Department of Health and Human Services, Office of Inspector General; and the Baton Rouge Office of the Social Security Administration.

Putnam Co. Woman Charged with TennCare Drug Fraud

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Friday, July 14, 2017

NASHVILLE, Tenn. – A middle Tennessee woman is charged with TennCare fraud involving the sale of prescription drugs which were obtained through TennCare benefits.

The Office of Inspector General (OIG) today announced the arrest of Kimberly Ann Smith, 31, of Cookeville, after a joint investigation with the Baxter Police Department.

Smith is charged with TennCare fraud for allegedly obtaining a prescription for the painkiller Oxycodone during a clinical visit paid for by TennCare, and later selling a portion of the drugs.

“We are working with municipal and county police officers across the state, as they often discover a connection to TennCare during local drug investigations,” Inspector General Manny Tyndall said.  “Local police are clearly committed to eliminating prescription drug abuse, and we’re doing our part to stop abusers who are supporting this lifestyle with TennCare.”

District Attorney General Bryant C. Dunaway is prosecuting. TennCare fraud is now a Class D felony punishable by up to four years in prison per charge.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to latest figures. To date, 2,871 people have been charged with TennCare fraud.

Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions. Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or visit the website and follow the prompts that read “Report TennCare Fraud.”

Three Companies and Their Executives Pay $19.5 Million to Resolve False Claims Act Allegations Pertaining to Rehabilitation Therapy and Hospice Services

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Monday, July 17, 2017

Ohio based Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia), and their executives, Brian Colleran (Colleran) and Daniel Parker (Parker), have agreed to pay approximately $19.5 million to resolve allegations pertaining to the submission of false claims for medically unnecessary rehabilitation therapy and hospice services to Medicare, the Department of Justice announced today.

“Clinical decisions should be based on patient needs rather than corporate profits,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “This settlement reflects the Department’s continuing commitment to safeguarding patients and the Medicare system.”

FHS is the corporate successor to Provider Services Inc. (PSI), which provided management services to skilled nursing facilities. In 2010, PSI was merged into BCFL Holdings Inc. (BCFL), which was renamed FHS in 2013. Olympia provided rehabilitation therapy services to patients at the skilled nursing facilities managed by PSI and BCFL. Tridia Hospice Care Inc. provided hospice care services. Colleran and Parker partially controlled or owned PSI, BCFL, FHS, Olympia, and Tridia between 2008 and 2013.

The settlement resolves allegations that, from January 2008 through December 2012, Olympia and PSI/BCFL submitted, or caused the submission of, false claims to Medicare for medically unnecessary rehabilitation therapy services at 18 skilled nursing facilities. The government contended that the therapy services were provided at excessive levels to increase Medicare reimbursement for those services.

The settlement further resolves allegations that, from April 2011 through December 2013, Tridia submitted false claims to Medicare for hospice services provided to patients who were ineligible for the Medicare hospice benefit because Tridia failed to conduct proper certifications or medical examinations. The settlement also resolves allegations that from January 2008 through December 2012, Colleran and Parker solicited and received kickbacks to refer patients from skilled nursing facilities managed by PSI or BCFL to Amber Home Care LLC, a home health care services provider.

“This is one of the largest nursing home operations in Ohio,” said U.S. Attorney Benjamin C. Glassman for the Southern District of Ohio. “It is unacceptable for an entity entrusted to care for our most vulnerable and elderly citizens to make decisions based on profit, not quality of care. Subjecting the elderly to inappropriate levels of therapy can be physically harmful, and failing to properly certify and re-certify hospice patients can have a devastating impact on the patients and their families.”

As part of the settlement, FHS and Colleran have entered into a five-year Corporate Integrity Agreement (CIA) with the HHS Office of Inspector General (HHS-OIG). The CIA is designed to increase the accountability and transparency of FHS and Colleran so that they will avoid or promptly detect future fraud and abuse.

“Medicare providers have a legal and moral obligation to provide only those services that are medically necessary and to ensure that claims seeking payment accurately reflect the services that are actually provided,” said Special Agent in Charge Lamont Pugh III of the U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG). “The misrepresentation or falsification of those claims not only violates provisions of the False Claims Act but the public’s trust. The OIG will continue to aggressively investigate allegations of potential violations of this nature.”

The settlement resolves allegations filed in two separate lawsuits by Vladimir Trakhter, a former Olympia employee, and Paula Bourne and La’Tasha Goodwin, former Tridia employees, in federal court in Columbus, Ohio. The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. Mr. Trahkter will receive approximately $2.9 million and Ms. Bourne and Ms. Goodwin collectively will receive $740,000.

The settlement is the result of a coordinated effort by the Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office for the Southern District of Ohio, with assistance from HHS-OIG, the HHS Office of Counsel to the Inspector General, and the Ohio Medicaid Fraud Control Unit.

These cases are captioned United States ex rel. Trakhter v. Provider Services, Inc., n/k/a BCFL Holdings, Inc., et. al., Case No. 1:11-CV-217, and United States ex rel. Bourne and Goodwin v. Brian Colleran, et. al., Case No. 1:12-CV-935. The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Two University of Missouri Physicians Plead Guilty to Health Care Fraud

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Wednesday, July 19, 2017

JEFFERSON CITY, Mo. – Tom Larson, Acting United States Attorney for the Western District of Missouri, announced today that two physicians at the University of Missouri School of Medicine in Columbia, Mo., have pleaded guilty in federal court, in separate cases, to engaging in a health care fraud scheme that totaled more than $190,000.

Kenneth Loem Rall, 82, and Michael Edward Richards, 65, both of Columbia, Mo., each waived his right to a grand jury and pleaded guilty before U.S. Magistrate Judge Matt J. Whitworth on Tuesday, July 18, 2017, to a federal information that charges him with one count of health care fraud.

Rall, who was employed at the university from July 1, 1998, until June 1, 2012, was chairman of the department of radiology at the School of Medicine until his resignation from that position on Dec. 20, 2011. Richards, who was head of mammography, was employed at the university from July 10, 2003, to June 1, 2012. Rall and Richards were both attending physicians in the university hospital, and teaching physicians and members of the faculty of the School of Medicine.

By pleading guilty, Rall and Richards each admitted that he signed interpretations of exams performed by residents at the hospital without actually viewing the images. Rall admitted that he caused more than $120,000 in fraudulent claims to be filed with federal health benefit programs from March 2010 through December 2011. Richards admitted that he caused more than $70,000 in fraudulent claims to be filed with federal health benefit programs from March 2010 through December 2011.

Federal health benefit programs (such as Medicare, Medicaid and Tricare) pay for the interpretation of diagnostic radiology and other diagnostic tests only if the interpretation is performed or reviewed by a teaching physician. If a resident prepares and signs the interpretation, the teaching physician must indicate that he or she personally viewed the relevant images and agrees with the resident’s interpretation, or edits the findings.

Rall and Richards admitted they falsely certified that they had viewed hundreds of files and records, when in fact they did not view the images. In each instance, the federal health benefit plan caused money to be paid, relying on their certification that they had done the work required by the pertinent regulations.

Under federal statutes, Rall and Richards are each subject to a sentence of up to 10 years in federal prison without parole. The maximum statutory sentence is prescribed by Congress and is provided here for informational purposes, as the sentencing of the defendant will be determined by the court based on the advisory sentencing guidelines and other statutory factors. A sentencing hearing will be scheduled after the completion of a presentence investigation by the United States Probation Office.

These cases are being prosecuted by Assistant U.S. Attorneys Lawrence E. Miller and Cindi S. Woolery. They were investigated by the U.S. Department of Health and Human Services – Office of the Inspector General, the Defense Criminal Investigative Service and the FBI.

Nine Miami-Dade Assisted Living Facility Owners Sentenced to Federal Prison for Receipt of Health Care Kickbacks

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Wednesday, July 19, 2017

Miami-Dade County assisted living facility owners, Marlene Marrero, 60, of Miami, Norma Casanova, 67, of Miami Lakes, Yeny De Erbiti, 51, of Miami, Rene Vega, 57, of Miami, Maribel Galvan, 43, of Miami Lakes, Dianelys Perez, 34, of Miami Gardens, Osniel Vera, 47, of Hialeah, Alicia Almeida, 56, of Miami Lakes, and Jorge Rodriguez, 57, of Hialeah, were sentenced to prison for receiving health care kickbacks. United States District Judge Marcia G. Cooke imposed sentences upon the nine defendants ranging from eight months to one year and one day, in prison. One assisted living facility owner, Blanca Orozco, 69, of Miramar, was sentenced to home confinement. In addition to their federal convictions, all ten defendants were also ordered to serve three years of supervised release, pay restitution and are subject to forfeiture judgments.

Benjamin G. Greenberg, Acting United States Attorney for the Southern District of Florida, Pam Bondi, Florida Attorney General, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), and George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, made the announcement.

All ten defendants previously pled guilty to receipt of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a-7b(b)(1)(A). According to court documents, these assisted living facility owners conspired with the former owner of Florida Pharmacy to receive kickbacks and bribes in exchange for referring beneficiaries living in their facilities for prescription medication and durable medical equipment paid for by Medicare and Medicaid. The assisted living facility owners participated in the fraudulent scheme, in violation of their Medicaid provider agreement as well as federal and state anti-kickback rules and regulations.

Mr. Greenberg commended the investigative efforts of the Medicare Fraud Strike Force participating partners, including HHS-OIG, the State of Florida’s Medicaid Fraud Control Unit, and the FBI. The case was prosecution by Special Assistant United States Attorney Hagerenesh Simmons.

The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

In addition, HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

Clinical Psychologist and Owner of Psychological Services Centers Sentenced to 264 Months for Roles in $25 Million Psychological Testing Scheme Carried out Through Eight Companies in Four States

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Friday, July 14, 2017

Two owners of psychological services companies, one of whom was a clinical psychologist, were sentenced yesterday for their involvement in a $25.2 million Medicare fraud scheme carried out through eight companies at nursing homes in four states in the Southeastern U.S.

The announcement was made by Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Duane A. Evans of the Eastern District of Louisiana, Special Agent in Charge Jeffrey S. Sallet of the FBI’s New Orleans Field Office and 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 Regional Office.

Rodney Hesson, 47, of Slidell, Louisiana, and Gertrude Parker, 63 of Slidell, Louisiana, were sentenced on July 13, to 180 months’ imprisonment and 84 months’ imprisonment by U.S. District Court Judge Carl J. Barbier of the Eastern District of Louisiana. Judge Barbier also ordered Hesson to pay $13,800,553.57 in restitution, and ordered Parker to pay $7,313,379.75 in restitution. The defendants were each convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to make false statements related to health care matters on January 24.

According to evidence presented at trial, Hesson and Parker’s companies, Nursing Home Psychological Services (NHPS) and Psychological Care Services (PCS), respectively, contracted with nursing homes in Alabama, Florida, Lousiana and Mississippi to allow NHPS and PCS clinical psychologists to provide psychological services to nursing home residents. Hesson and Parker caused these companies to bill Medicare for psychological testing services that these nursing home residents did not need or in some instances did not receive, the trial evidence showed. During trial, evidence was entered showing that between 2009 and 2015, NHPS and PCS submitted over $25.2 million in claims to Medicare, the vast majority of which were fraudulent, while Medicare paid more than $13.5 million on the fraudulent claims. The jury verdict included a money judgment of $8,956,278, as well as forfeiture of Hesson’s home and at least $525,629 in seized currency.

The case was investigated by the FBI and HHS-OIG, and brought by the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Louisiana. The case is being prosecuted by Senior Litigiation Counsel John Michelich and Trial Attorneys Katherine Raut and Katherine Payerle 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 over 3,000 defendants who collectively have billed the Medicare program for over $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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.