A court sentenced two doctors who were allowing a hospice to scam Medicare in Dallas, Texas. The U.S. Attorney announced that their charges for health care fraud resulted in a combined 23-year prison sentence.
The initial evidence
In May, two doctors and an accomplice were found guilty of conspiracy to commit health care fraud and other charges. The Chief U.S. Attorney sentenced the male doctor to 13 years in federal prison and $27,978,903 in restitution, and the female doctor was sentenced to 10 years in federal prison and $16,253,281 in restitution. An accomplice got 33 months in federal prison from a judge. The defendants were accused of admitting hospice patients illegally. The patients couldn’t apply for hospice but had false claims for services. Hospice law allows only select people to apply for hospice services.
The federal witnesses
One man pleaded guilty before the trial and testified against his bosses. According to his testimony, the doctors and nurses didn’t rely on medical professional opinions; they decided for themselves who to admit or discharge from hospice care. The patients’ drugs and doses were being decided by them as well. The doctors only pretended to have a face-to-face with the patients. Witnesses said that the two doctors were pre-signing blank controlled substance scripts without other doctors viewing them. The abused controlled substances included hydromorphone, morphine and fentanyl.
Hospice care fraud
The employees and nurses of the hospice care agency had pre-signed prescription pads from the doctors to give morphine to the patients. An accountant was able to dispense controlled substances without medical expertise. Medicare suspended payment because of suspicious billing. However, the group continued billing Medicare for the hospice services from another agency. Before the companies shut down, they scammed Medicare for about $40 million.
Under hospice law, the defendants violated their Hippocratic Oath and were lining their pockets at the expense of the patients. The case was in the spotlight because of a simple complaint that led to the FBI, the HHS-OIG and the Attorney General leading the investigation.