$90 million of fraud for Medicare in Houston
Article published on 2011/15/12 17:05
3 people were arrested in Houston for bilking Medicare out of $90 million. Two months ago, a Houston Chronicle investigation uncovered hundreds of millions in Medicare dollars spent to shepherd mentally fragile Texans by ambulance to mental health clinics and PHPs where patients claimed they watched TV and ate junk food.
2 physician owners of Spectrum Care in West Houston were charged in the alleged phony treatment scheme. It involved kickbacks to the owner of an assisted living facility in exchange for finding and funneling patients to the clinic. The owner of the home was also arrested.
All three are charged with conspiracy to commit health care fraud and conspiracy to pay and receive illegal health care kickbacks. The three defendants were paying Medicare beneficiaries cash and cigarettes if they came to Spectrum.
Since 2006, Center and Sajadi had been submitting bills to Medicare for supposed treatment at their "partial hospitalization program," known as a PHP.
According to the indictment, the Spectrum Care owners submitted $90.4 million in claims starting in 2006 even though the PHP services "were not medically necessary, and in some cases, never provided."
Texas Medical Board records show the agency disciplined Sajadi last February for failing to keep good records on a patient. The doctor did not admit to or deny the findings but agreed to complete in one year, eight hours of continuing education on medical record-keeping. In 2005, Sajadi was ordered by the board to complete nine hours of ethics courses, pay a $1,000 fine for violating a state law that requires a doctor who denies medical records to explain why the information was not provided.
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