Monday, a Louisiana psychiatrist was sentenced to serve 86 months in prison for his role in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric services. In addition, he was ordered to pay $43.5 million in restitution and to forfeit all proceeds from the fraudulent scheme.
As part of the scheme, the psychiatrist admitted mentally ill patients to facilities, "some of whom were inappropriate for partial hospitalization, and then re-certified the patients' appropriateness for the program in an effort to continue to bill Medicare for services." The psychiatrist and others involved falsified patient treatment records to reflect services on dates when no services were provided. The psychiatrist pleaded guilty on May 13, 2014, to conspiracy to commit health care fraud.
The investigation resulted in 17 convictions of individuals employed by three mental health centers, including therapists, marketers, administrators, owners and the medical director. Collectively, more than $258 million in claims were submitted to Medicare during a seven year period for partial hospital program services for the mentally ill that were unnecessary or never provided. Medicare paid approximately $43.5 million on those claims.
The Centers for Medicare and Medicaid Services (CMS) is working with the Office of the Inspector General (OIG) to take steps to increase accountability and decrease the presence of fraudulent providers.
To ensure you are up to date on CMS and OIG regulations, we highly recommend organizations taking advantage of customizing their corporate compliance and fraud, waste and abuse programs and providing employee training on these programs if you are not already.
If you have any additional questions about our Corporate Compliance or Fraud, Waste and Abuse training, please do not hesitate to contact one of our professional consultants.