The FBI says Medicare fraud costs Americans $80 billion per year. As much as ten cents of every dollar spent on healthcare is waste and fraud. Beyond the economic losses, millions of people must wait to see physicians or receive care because there just isn’t enough money to fund everything.
Medicaid and Medicare fraud makes me outraged. And it should make you angry too. A few greedy doctors, hospitals, nursing homes and pharmaceutical companies are pocketing billions of dollars of our hard earned money every year.
In this post we will hear about convicted father and son fraudsters upset because they must go to prison. Earlier this week a former Houston hospital president was sentenced on Tuesday to 45 years in prison after being found guilty of facilitating a $158 million Medicare fraud and kickback scheme.
One of the worst places in the country for Medicare fraud is Houston. (Miami reigns as number one with Detroit, Philadelphia and New Orleans vying for top “honors” too.) A federal judge in Houston isn’t taking the problem lightly, however. Judge Lee Rosenthal sent the former president of Riverside General Hospital, Earnest Gibson III, to 45 years in prison. Gibson must live to be 108 years old before being eligible for release.
Gibson’s son, Earnest IV, who operated a psychiatric facility affiliated with the hospital was sentenced to 20 years.
In addition to healthcare fraud charges, the father and son were also convicted of money laundering charges.
Immediately after sentencing, the senior Gibson filed an appeal. He asked the court to allow him to be free until his appeal could be heard. Gibson’s lawyer told the judge that the jury didn’t have enough information to convict. His son has appealed as well.
Although Gibson might think a jury of his peers wronged him, the Justice Department minced no words after his sentencing. Said Assistant Attorney General Leslie Caldwell,
“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 long-standing hospital into the ground through their greed and fraud.”
The indictment claimed that the Gibsons billed for services that were not medically necessary and also billed for services that were never even provided. Court records also show that Gibson III caused kickbacks and bribes to be paid to patient recruiters, group homes and nursing homes.
We have seen many Medicare fraud cases that rely on patient recruiters and bribes. In exchange for cash, patient recruiters typically round up homeless people and bring them in for services they don’t need. Nursing home staff will sometimes also accept kickbacks and refer their patients to clinics.
The indictment says that to keep patients from leaving, they would receive bribes in the form of cigarettes, food and coupons redeemable at the hospital’s “country store.” Instead of providing psychiatric services, staff let the patients watch TV and play games. Unfortunately, Medicare paid out over $158 million for these “services”.
That is, taxpayers paid out over $158 million.
Gibson senior and his son were not alone. Several others were indicted. All that have been sentenced thus far have received stiff prison sentences. It appears all are appealing.
We take our blog seriously and try not to editorialize. Watching the defendants in this case all appeal, however, is simultaneously amusing and disturbing. We are not sure what they expected when sentenced. Many white-collar defendants historically received light “country club” sentences. Those days are ending. As Medicare fraud reaches epidemic proportions, judges are throwing the book at these scam artists and juries are getting sick of it too.
We are not sure how this case started. Most Medicare fraud cases begin when a whistleblower comes forward. Under the federal False Claims Act, whistleblowers can receive a percentage of whatever the government collects from wrongdoers.
The most frequent whistleblowers in these cases are billing clerks and patient recruiters who realize what they are doing is wrong and decide to come clean.
Last year the federal government paid $635 million in whistleblower awards, most of those awards being in Medicare fraud cases. Our clients have to date collected over $100 million in awards.
Have inside information about Medicare or Medicaid fraud? Give us a call. All inquiries are protected by the attorney – client privilege and kept strictly confidential. We will always evaluate your case for free. For more information, contact attorney Brian Mahany at or by telephone at (direct).
MahanyLaw – America’s Medicare Fraud Lawyers