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From Health Law Daily, June 10, 2015

CEO of historic Houston hospital gets 45 years for $158M in bogus partial hospitalization program billings

By Harold M. Bishop, J.D.

Earnest Gibson III, age 70, the former president of Riverside General Hospital in Houston, Texas; his son Earnest Gibson IV, age 37, the operator of Devotions Care Solutions, a satellite psychiatric facility of Riverside; and Regina Askew, age 50, the owner of Safe and Sound group home were sentenced today to 45 years, 20 years, and 12 years in prison, respectively, for their roles in a $158 million partial hospitalization program (PHP) service fraud conspiracy. A PHP is a form of intensive outpatient treatment for severe mental illness.

Riverside General Hospital, which was known as the Houston Negro Hospital until 1961, was very important to Houston’s African-American community during the segregation era.

Restitution. In addition to their prison terms, the U.S. Department of Justice (DOJ) announced that Earnest Gibson III was ordered to pay restitution in the amount of $46.7 million, Earnest Gibson IV was ordered to pay restitution in the amount of $7.5 million, and Regina Askew was ordered to pay restitution in the amount of $46.3 million.

Verdicts. After a five-week jury trial, the conspirators were all convicted of conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks, and related counts of paying or receiving illegal kickbacks. Earnest Gibson III and Earnest Gibson IV also were convicted of conspiracy to commit money laundering. Another co-defendant, Robert Crane, a patient recruiter, also was convicted of conspiracy to pay and receive kickbacks. Crane will be sentenced on December 9, 2015.

Evidence. According to the DOJ, the trial evidence showed that from 2005 until June 2012, the conspirators and others engaged in a scheme to defraud Medicare by submitting through Riverside and its satellite locations, approximately $158 million in false and fraudulent claims for PHP services. Specifically, evidence at trial demonstrated that:

  • The Medicare beneficiaries for whom Riverside billed Medicare did not qualify for or need PHP services.

  • The Medicare beneficiaries rarely saw a psychiatrist and did not receive intensive psychiatric treatment.

  • Some of the beneficiaries were suffering from Alzheimer’s and could not actively participate in the treatment for which Medicare was billed.

  • Earnest Gibson III paid kickbacks to patient recruiters and to owners and operators of group care homes, including Regina Askew, in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs.

  • Earnest Gibson IV paid patient recruiters, including Robert Crane and others, to deliver ineligible Medicare beneficiaries to the specific PHP operated by Earnest Gibson IV.

Other conspirators. The DOJ reports that six other individuals have pleaded guilty based on their involvement in the scheme. These individuals include Mohammad Khan, an assistant administrator at Riverside, who pleaded guilty to conspiracy to commit health care fraud, conspiracy to defraud the United States and to pay illegal kickbacks, and five counts of paying illegal kickbacks. Mohammad Khan was sentenced to 40 years in prison for his role in the scheme on May 21, 2015. William Bullock, an operator of a Riverside satellite location, Leslie Clark, Robert Ferguson, Waddie McDuffie and Sharonda Holmes also pleaded guilty to participating in the scheme and await sentencing.

Companies: Riverside General Hospital; Devotions Care Solutions; Safe and Sound; Federal Bureau of Investigation; U.S. Department of Justice, Internal Revenue Service; Texas Attorney General’s Medicaid Fraud Control Unit; HHS Office of Inspector General; Railroad Retirement Board’s Office of Inspector General; Office of Personnel Management’s Office of Inspector General

MainStory: TopStory AgencyNews ReimbursementNews ComplianceNews CMSNews AntikickbackNews EnforcementNews FCANews FraudNews OPPSNews PartBNews PaymentNews TherapyNews

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