Monday, December 26, 2016

Houston Psychiatrist Sentenced to Long Sentence (144 Months) in Prison for Role in False Claims for Mental Health Treatment and Partial Hospitalization Program

When physicians refer or admit patients to a hospital or outpatient program, if there is deemed to be a lack of medical necessity or fraud, the physician can be held liable on conspiracy theory for the full amount of the billings and face a sentence far greater than ever imagined. When there is marketing to the patients that compounds the issues.

A recent case shows how a psychiatrist, Sharon Iglehart, M.D. a former attending psychiatrist at Riverside General Hospital (Riverside) of Houston, received a lengthy sentence (144 months) even though she is a first time offender after going to trial. 

It also shows how sentences vary case by case and judge by judge. Further, the sentences one defendant receives in a multi-defendant case is strongly affected by co-defendants' sentences.

After a 7-day trial in September 2015, Dr. Iglehart was convicted by the jury of one count of conspiracy to commit health care fraud, one count of health care fraud and three counts of making false statements relating to health care matters. 

In April 2016, Dr. Iglehart was sentenced by U.S. District Judge Ewing Werlein Jr. of the Southern District of Texas to a very heavy 144 months in prison for her role in the case. Judge Werlein also ordered Dr. Iglehart to pay $6,363,528.82 in restitution and to forfeit the same amount. The government alleged that there was a total of $158 million in Medicare billings related to her conduct. 

According to evidence presented at trial, from 2006 until June 2012, Dr. Iglehart and others submitted through Riverside approximately $158 million in false and fraudulent claims to Medicare for partial hospitalization program (PHP) services, an intensive outpatient treatment for severe mental illness.  The government presented evidence at trial showing that the Medicare beneficiaries for whom Riverside billed Medicare did not receive PHP services.  In fact, the government alleged that its evidence proved that most of the Medicare beneficiaries rarely saw a psychiatrist and did not receive intensive psychiatric treatment at all.

In addition, the government presented evidence at trial that Dr. Iglehart personally billed Medicare for individual psychotherapy and other treatment purportedly provided to patients at Riverside locations – allegedly treatment that she never provided.  Further, the government contended that Dr. Iglehart falsified the medical records of patients at Riverside’s inpatient facility to make it appear as if she provided psychiatric treatment when she did not. Patients were allegedly recruited with gifts by the facilities and kickbacks were paid to patient recruiters, group home owners and assisted living facility owners. The illegal marketing often underlies these type of cases which turns all claims (even if provided and medically necessary) into real problem with kickbacks is that it makes the entire claim a "false claim."

One of the reasons that the sentence may have been long is that the total billing amounts were very large and 12 other individuals were convicted based on their roles in this particular case and already sentenced after a jury trial in October 2014. Those convicted and sentenced included: 
(1) Earnest Gibson III (71 year old former president of Riverside - 45 years in prison);
(2) Earnest Gibson IV (operator of a Riverside PHP satellite locations - 20 years in prison);
(3) Regina Askew (a group home owner and patient file auditor- 12 years in prison); and
(4) Robert Crane (a patient recruiter - not sentenced yet).

Even one of the defendants who pleaded guilty, Mohammad Khan, an assistant administrator at the hospital who managed many of the hospital’s PHPs, was sentenced to 40 years in prison. Judge Werlein sent a strong message with these sentences - which given the age of some of the defendants is a life sentence.

Why the long sentences? The conduct over years of time adds up to to astronomical amounts of money. Judge Werlein appeared to have been taken into account the years of wrongdoing, the systemic issues and marketing and fraud issues, and the amounts billed to and paid by Medicare. This is also part of the overall attack on white collar offenses and imposing longer sentences to deter misconduct in billing government health care programs.  

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Phone: 213-233-2260


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