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Texans busted for fraud involving psychiatric care


Alleged and proven healthcare fraud made headlines recently with the indictment and convictions of mental health service providers in Texas.

Authorities charged San Angelo psychiatrist Robert H. Gross, M.D., with 52 counts of healthcare fraud, the U.S. Department of Justice announced. Gross allegedly ran a five-year scheme to defraud Medicare, Medicaid and commercial insurers. He reportedly billed for services that were either not rendered or filed under inflated procedures codes. Billings in this case totaled nearly $1.75 million.

Gross allegedly billed for services to nursing home residents on dates when he didn't see them. Some, for example, had died or were discharged before Gross's claimed visits, according to the government's case.

If Gross is convicted, each healthcare fraud count carries a maximum penalty of 10 years behind bars and a $250,000 fine.

Meanwhile in Houston, a federal grand jury convicted Earnest Gibson III, president of Riverside General Hospital, his son and two others for their roles in a $158 million Medicare scam involving partial psychiatric hospitalization program services, according to the DOJ. Ten defendants have now been convicted in this case.

"For over six years, the Gibsons and their co-conspirators stuck taxpayers with millions in hospital bills, purportedly for intensive psychiatric treatment," said Texas Assistant Attorney General Leslie R. Caldwell in the announcement. "But the 'treatment' was a sham--some patients just watched television all day, others had dementia and couldn't understand the therapy they supposedly received, and other patients never even went to the hospital at all."

Evidence also showed Gibson paid kickbacks to recruiters and owners of group care homes for delivering ineligible beneficiaries to the hospital, the DOJ noted.

Riverside Hospital has been on the brink of financial ruin since most of its federal funding was cut off after an indictment was unsealed in late 2012, the Houston Chronicle reported.

For more:
- read the DOJ announcements on Gross and Riverside Hospital
- read the Houston Chronicle article

Related Articles:
When fraud becomes a family affair
Psychiatrist sent to prison for role in $258M fraud
Mental health scams target Medicare and Medicaid
Auditors: Texas must ramp up Medicaid anti-fraud efforts
A Texas-sized fraud settlement mess