April 9, 2014 — The country’s Medicare program is funded by the federal governments to assist the nation’s seniors. Medicare fraud by unprincipled medical providers just drives up health care costs for taxpayers everywhere. The U.S. Department of Justice (DOJ) counts on whistleblowers with a conscience to spot Medicare fraud and notify the government by bringing a False Claims Act lawsuit. The statute’s qui tam provisions give health care insiders a way to do what’s right. Informants who file suit on the government’s behalf may be compensated with a sizeable share of any proceeds from the suit.
Houston Partial Hospitalization Program Provider Submits $97 Million in False Claims to Medicare
A Houston jury has convicted seven defendants charged for their roles in a $97 million health care fraud scheme. Those convicted include Mansour Sanjar and Cyrus Sajadi, two doctors who owned Spectrum Care P.A. (Spectrum), a former Houston company providing mental health care. Also convicted were the following: Adam Main, a physician’s assistant; Shokoufeh Hakimi, Spectrum’s administrator; Chandra Nunn and Shawn Manney, group home owners; and Sharonda Holmes, a patient recruiter.
According to the DOJ, Sanjar and Sajadi orchestrated the Medicare fraud operation that ran from 2006 to 2011. Spectrum was a purported provider of partial hospitalization program (PHP) services — an intensive type of outpatient treatment for patients with severe mental illness. In reality, however, Spectrum’s owners and its administrator paid kickbacks to group home owners and patient recruiters to identify ineligible Medicare beneficiaries who could be referred to Spectrum for “treatment.” At times, the patients also received a cut of the kickbacks.
Spectrum’s recruits did not need PHP services, did not qualify for PHP services and did not receive PHP services. Instead, the patients played games, colored in coloring books or watched movies. Nevertheless, Spectrum’s owners billed Medicare for such “services.” Indeed, Spectrum submitted around $97 million in false claims to Medicare.
Sentencing in the case is scheduled to take place in September.
Health Care Insiders Key to Fighting Illegal Kickbacks that Rob from Medicare Programs
Health care employees who work in billing and accounting may be the first to root out False Claims Act violations. But most insiders have no idea about how to bring a whistleblower lawsuit. With qui tam lawyers in Texas, where the fraud in this case occurred, and in California and the Washington D.C. area, Waters & Kraus guides whistleblowers through the process, protecting their interests. Contact us by email or phone our False Claims Act attorneys at 855.784.0268 to learn more about collaborating to fight Medicare fraud.
