A Houston-area psychiatrist has been convicted by a federal jury for his role in a $158 million Medicare fraud scheme, according to the US Department of Justice (DOJ).
Riaz Mazcuri, MD, 65, from Harris County, Texas, who also spells his name Riyaz Mazkouri, according to his indictment last year, was convicted May 23 of one count of conspiracy to commit healthcare fraud and five counts of healthcare fraud.
According to evidence from the trial, the scheme involved the following:
Dr Mazcuri and others submitted $158 million in false claims, through Riverside General Hospital in Harris County and its satellite locations, for intensive outpatient treatment for severe mental illness known as a partial hospitalization program (PHP) from 2006-2012.
Riverside, then, paid bribes and kickbacks to group-home owners and nursing home employees in exchange for them sending Medicare patients to its PHPs.
The DOJ states in a news release that, "Mazcuri indiscriminately admitted and readmitted these patients into these intensive psychiatric programs — often for years on end."
According to the trial evidence, many of the patients had severe Alzheimer's or dementia and therefore didn't qualify for the PHP services and Dr Mazcuri rarely saw them, stopping into the PHPs only to sign in weekly and make brief visits.
Trial evidence also showed that Riverside did not actually provide the PHP services, but submitted fake documents to Medicare saying it did.
According to information in the indictment, Dr Mazcuri allowed the hospital to use his name as an attending physician on the documents to make the claims look legitimate. He would also individually submit the claims for the unnecessary services using his own provider number.
His signature on documents enabled Riverside to bill Medicare for $55 million of the total $158 million, according to trial evidence.
Sentencing for Dr Mazcuri has been scheduled for October 10, 2017.
"Greed and Fraud"
Among the others convicted in the scheme, and their prison sentences, are:
Earnest Gibson III, former president of Riverside, 45 years
Earnest Gibson IV, operator of one of Riverside's PHP satellite locations, 20 years
Regina Askew, a group-home owner and patient file auditor, 12 years
Robert Crane, a patient recruiter, not yet sentenced
Mohammad Khan, an assistant administrator at Riverside, 40 years
Sharon Iglehart, MD, 12 years
Walid Hamoudi, MD, 5 years
In its news release in June 2015 regarding the conviction of Earnest Gibson III, the DOJ quoted Assistant Attorney General Leslie R. Caldwell of the Justice Department's Criminal Division, as saying:
"The former President of Houston's Riverside hospital, his son and their co-conspirators saw mentally ill, elderly and disabled Medicare beneficiaries as commodities to be turned into profit centers — not as vulnerable individuals in need of health care. Rather than providing needed medical care to a historically underserved community, the defendants ran a longstanding hospital into the ground through their greed and fraud."
The case was brought as part of the Medicare Fraud Strike Force, which operates in nine cities nationwide. Since 2007, the strike force has charged nearly 3000 defendants who have billed Medicare for more than $11 billion.
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*Article curated as: Houston Psychiatrist Convicted in $158 Million Medicare Scam - Medscape - Jun 01, 2017.