Medicare Fraud Spreads to Mental Health Field

Everybody’s getting in on it now. Medicare fraud, that is. Even psychiatrists and other so-called mental health professionals.

Let’s start with the co-owner of a community mental health center in Baton Rouge, Louisiana. Roslyn F. Doga, 53, was sentenced to 90 months in prison and ordered to pay $43.5 million in restitution after being convicted on health care fraud charges.

In came out at her trial that Doga recruited Medicare beneficiaries who were living in nursing homes and assisted living facilities to enter the partial hospitalization psychiatric programs at her business and two other treatment centers knowing the individuals did not need the psychotherapy treatment. She then kept the patients at the facilities for as long as possible without raising suspicion.

James R. Hunter, 48, of Houston Texas, got a 60-month sentence and a $3.2 million restitution bill for recruiting Medicare beneficiaries to attend the PHP program at a mental health center in exchange for $1,500 a week in cash. Hunter recruited Medicare recipients from group homes who were not appropriate for PHP services, but who agreed to attend the program in exchange for $75 cash a week.

Hunter coached each beneficiary on what to say to physicians regarding their supposed psychiatric symptoms. As a result of the kickback scheme with Hunter, the facility billed Medicare approximately $16.5 million.

Some other cases involving mental health care:

  • Charges were filed against Andrew Newton of Harrisburg, Pennsylvania, a psychiatrist with an office in Mount Carmel. Between August 2010 and November 2011, Newton allegedly billed Medicare for face-to-face therapy sessions when he was in fact out of the country. He faces a maximum penalty of six years in prison, a term of supervised release following imprisonment, and a fine.
  • Christopher Gabel, 61, of Davie, Florida, entered a guilty plea for his role in a mental health care fraud scheme that resulted in the submission of more than $67 million in fraudulent claims to Medicare by a psychiatric hospital in Hollywood, Florida. Gabel was chief operating officer of Hollywood Pavilion LLC. According to the plea, the treatment center submitted false and fraudulent claims to Medicare for treatment that was not medically necessary or not provided to patients. Also, Medicare beneficiaries were admitted to the center regardless of whether they qualified for mental health treatment or not, and were often admitted before seeing a doctor.

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