Houston Psychiatrist Sentenced to More Than 12 Years in Prison for Role in $155 Million Medicare Fraud Scheme

A Houston psychiatrist was sentenced to 150 months in prison for his role in a $155 million Medicare fraud scheme involving false and fraudulent claims for psychiatric services.

Assistant Attorney General Brian A. Benczkowiski of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health Services-Offices of Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge D. Richard Goss of TRS Criminal Investigation’s (IRS-C) Houston Field Office, Special Agent in Charge Kristin Osswald of the Railroad Retirement Board Office of Inspector General’s (RRB-OIG) Chicago Regional Office, and Unit Division Chief Stormy Kelly of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

Riyaz Mazcuri, 67, a former attending psychiatrist at Riverside General Hospital (Riverside) of Houston, was sentenced by U.S. District Judge Vanessa D. Gilmore of the Southern District of Texas. Judge Gilmore also ordered Mazcuri to pay $20,607,410.22 in restitution to Medicare and $2,250,789.69 in restitution to Medicaid.

On May 20, 2017, following a five-day trial, a jury convicted Mazcuri of one count of conspiracy to commit health care fraud, and five counts of health care fraud.

According to the evidence at trial, from 2006 until Feb. 2012, Mazcuri and other engaged in a scheme to defraud Medicare by submitting to Medicare, through Riverside, approximately $155 Million in false and fraudulent claims for partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for patients with a severe mental illness.

In addition, the evidence presented at trial showed that Mazcuri indiscriminately admitted and readmitted patients into these intensive psychiatric – often for years on end – many of whom suffered from Alzheimer’s or dementia and were unable to participate in the treatment purportedly provided to the PHP’s, and who therefore did not qualify for the services. Evidence also showed that Mazcuri falsified medical records and signed false documents to make it appear as if patients admitted to the PHP’s qualified for, and actually received the intensive psychiatric services.

Evidence also demonstrated that Mazcuri personally billed Medicare for the psychiatric treatment he purportedly provided to Riverside’s PHP patients – treatment he never actually provided. Mazcuri signature on patient’s documents enabled Riverside to bill Medicare for over $55 million of the total $155 million that Riverside billed Medicare for fraudulent psychiatric services, the evidence showed.

To date, 15 others have been convicted of offenses based on their roles in the fraudulent scheme., including Earnest Gibson III, 73, the former president of Riverside, Earnest Gibson IV, 41, the operator of one of Riverside’s PHP satellite locations; Regina Askew, 53, a group home owner and patient file auditor; and Robert Crane, 61, a patient recruiter, all of whom were convicted after a jury trial in 2014. Earnest Gibson III was sentenced to 45 years in prison. Earnest Gibson IV was sentenced to 20 years in prison. Regina Askew was sentenced to 12 years in prison. Robert Crane has not yet been sentenced. Mohammad Khan, 68, an assistant administrator at the hospital, who managed many of the hospital’s PHP’s pleaded guilty and was sentenced to 40 years in prison. Sharon Inglehart, 61, a physician, was convicted after a jury trial in August 2015. She was sentenced to 12 years in prison. Walid Hamoudi, 66, a physician, pleaded guilty in August 2015. He was sentenced to five years in prison.

The Medicare Strike Force Operation is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and detour fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 areas nationwide. Since its inception in March 2007, the Medicare the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5billionn.

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