Four Charged in $32 Million Healthcare Fraud Scheme

A medical director, operator and two unlicensed practitioners at a Texas medical clinic are now in custody on charges related to their alleged participation in a $32 million health care fraud scheme.

[Deidentified] and [Deidentified] are the medical director and operator, respectively, of Hillcroft Physicians, while [Deidentified] and [Deidentified] were former unlicensed practitioners there.

The indictment, unsealed today, charges all four with one count of conspiracy to commit health care fraud. [Deidentified] , [Deidentified] and [Deidentified] are also charged with five counts of making false statements relating to health care matters.

The indictment alleges the defendants participated in a health care fraud scheme. They allegedly submitted false and fraudulent claims to Medicaid and Medicare for services that were not provided as billed or were not provided by a licensed, qualified and enrolled provider. [Deidentified], [Deidentified], [Deidentified],and [Deidentified] allegedly misled patients and staff to believe that [Deidentified] and [Deidentified] were licensed to practice medicine in Texas.

According to the indictment, [Deidentified] and [Deidentified] directed [Deidentified] and [Deidentified] to pose as licensed medical professionals. [Deidentified] and [Deidentified] then allegedly examined, diagnosed, treated, referred and prescribed drugs for patients, many of whom were non-English speaking Medicaid clients unfamiliar with the American medical system. [Deidentified] and [Deidentified] allegedly directed Hillcroft Physicians’ billing staff to submit false claims to Medicaid and Medicare as though [Deidentified] had seen and treated the patients, even when [Deidentified] was out of the country.

The indictment alleges that the defendants submitted or caused the submission of approximately $31 million in claims to Medicaid for which Medicaid paid approximately $12.2 million. They also submitted approximately $600,000 in claims to Medicare for which Medicare paid approximately $250,000.

The FBI, Department of Health and Human Services (DHHS) – Office of Inspector General and Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation. Immigration and Customs Enforcement’s Homeland Security Investigations assisted with the arrests.

Trial Attorney Devon Helfmeyer of the Criminal Division’s Fraud Section and Special Assistant U.S. Attorney Kathryn Olson of the Southern District of Texas are prosecuting the case.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the DHHS Centers for Medicare & Medicaid Services, working in conjunction with DHHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.