Houston physician found guilty for role in $1.5M fraud scheme

Following a four-day trial, a Houston-area physician was convicted of conspiracy to commit health care fraud and conspiracy to pay and receive illegal kickbacks in a scheme involving home health services involving Allied Covenant Home Health, Inc. (Allied). Sentencing is scheduled for September 25, 2017.

Scheme

According to the Department of Justice (DOJ), the physician was involved in a scheme to defraud Medicare by submitting $1.5 million in fraudulent claims from 2006 to 2013. Evidence showed that the physician admitted patients for home health services through Allied without regard for qualification for such services. The physician falsified medical records and signed false documentation to show that patients met Medicare criteria for home health service reimbursement when they did not.

The evidence also showed that the physician paid illegal kickbacks to the owner of Harris Health Care Group (Harris). These kickbacks were paid in order to facilitate Medicare billing for facet injections. These injections were not medically necessary or not provided.