A Texas man was extradited to Houston on December 10, 2021, to begin an 80-year prison sentence that he received in absentia four years earlier after pleading guilty in two separate cases to conspiracy, healthcare fraud, money laundering, and tax offenses.
Court documents state that in November 2016, the Texas man and his wife went to trial on the conspiracy, healthcare fraud, and money laundering charges. Evidence at the trial showed that between 2006 and 2015, the Texas man, his wife, and their co-conspirators used their healthcare company to obtain more than $13 million by submitting false and fraudulent claims to Medicare for home health care services that their patients did not receive or that were not medically necessary. Documents from the trial and court showed that the Texas man and his wife paid illegal kickbacks to patient recruiters for referrals, and that the Texas man falsified and directed others to falsify medical records to make it appear as though the patients met the Medicare qualification for home health care. Additional evidence showed that the duo attempted to destroy evidence and blackmail and suborn perjury from witnesses (persuade them to swear under oath to tell the truth, but lie.) After the first week of trial, the Texas man pled guilty to one count of conspiracy to commit healthcare fraud, three counts of healthcare fraud, one count of conspiracy to pay and receive healthcare kickbacks, three counts of payment and receipt of healthcare kickbacks, and one count of conspiracy to launder monetary instruments.
Then in June 2017, the Texas man pled guilty in a separate case to two counts of filing fraudulent tax returns. In connection to the guilty plea, the Texas man admitted that he created a physical therapy shell company to limit the amount of tax that he paid to the IRS on the proceeds that he and his co-conspirators stole from Medicare. Per his plea agreement, in 2013 and 2014 he wrote almost $1 million in checks from his home health care company to the shell company for physical therapy services that the shell company never provided to patients, and that he deducted as business expenses. He also admitted that his tax fraud scheme caused the IRS a tax loss of approximately $344,452.
The Texas man was sentenced to 75 years in prison in August 2017 for the Medicare fraud scheme. In October 2017, on the day of the sentencing hearing, the Texas man removed his monitoring bracelet and did not respond to phone calls or appear in court for the sentencing hearing. In December 2017, he was additionally sentenced in absentia to 80 years in prison for his role in the Medicare and tax fraud schemes.
In September 2021 a decree was signed by the President of the Republic of Cameroon ordering the removal of the Texas man back to the United States. He was brought back to the United States by U.S. Marshals to the United States to begin serving his sentence.
Issue:
The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care. Routine audits should be conducted of monetary transactions, with the results of the audits reported to the compliance and ethics committee and to the governing body. The audits must include a corrective action plan if a discrepancy is found, and all discrepancies should be fully investigated and rectified immediately. It is imperative that every facility have an effective compliance and ethics committee to reduce the likelihood of healthcare fraud, waste, and abuse of government funds in their setting.
Discussion Points:
- Review your policies and procedures for operating an effective Compliance and Ethics Program and for conducting billing to Medicare, Medicaid, and third party payors. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually. Ensure that appropriate staff members are trained in approved billing procedures and demonstrate competence. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report violations to their supervisor, the compliance officer, or via the anonymous hotline.
