Assisted living figures into one of the highlights of 2015 for the U.S. Department of Health and Human Services’ Office of Inspector General.
The OIG, in its recent Semiannual Report to Congress (PDF), cited as an accomplishment in the April to September time period the Southern Texas Medicare Fraud Strike Force efforts that resulted in the sentencing of Earnest Gibson III, Earnest Gibson IV, Mohammad Kahn and Regina Askew. The four were sentenced to a combined 117 years of incarceration and also were ordered to pay more than $46 million in joint and several restitution after being convicted of conspiracy to commit healthcare fraud and conspiracy to pay and receive kickbacks. The Gibsons also were also convicted of conspiracy to commit money laundering.
In the scheme, more than $158 million in false claims were submitted to Medicare for partial hospitalization program services that were medically unnecessary, not eligible for reimbursement and not provided, according to the OIG. The defendants reportedly offered and paid kickbacks to assisted living facility owners, group home owners and patient recruiters in exchange for sending Medicare beneficiaries to Riverside General Hospital and its satellite facilities. At the hospital, the patients watched television, played games and engaged in other activities instead of receiving the services for which the hospital billed Medicare.
The OIG is required by law to report on its activities twice a year to the head of the department and to Congress.