Insurance Fraud NEWS
Hospital admin pays kickbacks for patients in $16M Texas con
October 09, 2018, Houston, TX
A federal jury convicted a Houston-area hospital administrator on Friday for his role in a $16 million Medicare fraud scheme.
Assistant Attorney General Brian A. Benczkowski 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 and Human Services-Office of Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge D. Richard Goss of IRS Criminal Investigation’s (IRS-CI) Houston Field Office, and Unit Division Chief Stormy Kelly of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
Starsky D. Bomer, 45, of Harris County, Texas, was convicted of one count of conspiracy to pay and receive healthcare kickbacks, two counts of violating the Anti-Kickback Statute, and one count of conspiracy to commit health care fraud following a five-day trial. Sentencing has been scheduled for Jan. 28, 2019 before U.S. District Judge Vanessa D. Gilmore of the Southern District of Texas, who presided over the trial.
According to evidence presented at trial, from 2011 until February 2013, Bomer and others engaged in a scheme to defraud Medicare by submitting to Medicare, through Atrium Medical Center (Atrium) and Pristine Healthcare (Pristine), approximately $16 million in false and fraudulent claims for partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness.
The evidence presented at trial showed that Bomer, the hospitals’ chief financial officer and chief operating officer, orchestrated a scheme by which he and others paid illegal bribes and kickbacks to group home owners and patient recruiters in exchange for sending Medicare patients to Atrium and Pristine’s PHPs. Bomer disguised bribes and kickbacks as salary payments and transportations payments to group home owners in exchange for patient referrals, the evidence showed. In addition, evidence presented at trial showed that Bomer knew that most of the patients admitted to Atrium and Pristine’s PHPs did not qualify for and were never provided legitimate partial hospital services.
Evidence at trial demonstrated that Bomer and his coconspirators billed Medicare over $16 million for psychiatric treatment purportedly provided to PHP patients at Atrium and Pristine’s PHPs.
The case was investigated by the HHS-OIG, FBI, IRS-CI, OPM-OIG, and MFCU. The case was prosecuted by Trial Attorneys Jason Knutson, Aleza Remis, and Gerald M. Moody Jr. of the Criminal Division’s Fraud Section.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in 12 cities across the country, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.
Source: The United States Department of Justice