Federal Grand Jury Charges San Angelo Psychiatrist with 52 Counts of Health Care Fraud
LUBBOCK, TX—A licensed psychiatrist, who submitted claims for services rendered to nursing home residents in San Angelo, Texas, and other communities in the counties surrounding Tom Green County, Texas, is in federal custody on charges that he defrauded Medicare and Medicaid of nearly $1.75 million, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Robert Hadley Gross, who is licensed by the Texas Medical Board with a primary practice in psychiatry, is charged in an indictment returned yesterday by a federal grand jury in Lubbock, Texas, with 52 counts of health care fraud. Gross was arrested yesterday evening at his office in San Angelo and is scheduled to make his initial appearance before a U.S. Magistrate Judge today in Abilene, Texas.
The indictment alleges that beginning in approximately January 2009 and continuing to approximately June 20, 2014, Gross ran a scheme to defraud Medicare and Medicaid, and other health insurance carriers, by filing claims for payment for services that were never rendered and for services that were billed using inappropriate CPT codes. When submitting a claim, the provider identifies the type of service performed in each submitted claim by means of a code for the type of service listed in the American Medical Association’s publication called the Current Procedural Terminology (CPT) Manual. This five-digit code dictates the amount of payment the provider receives for the rendered service.
In addition to regularly submitting claims for services rendered to nursing home residents, Gross also regularly submitted claims for services provided to clients of mental health and mental retardation (MHMR) organizations in San Angelo, Midland, and Abilene, Texas, in addition to claims for services rendered to patients in his office in San Angelo. In addition, during 2009 and 2010, Gross submitted claims for services provided to foster care children in Brownwood, Texas.
As part of his scheme, according to the indictment, Gross, for numerous dates of service, filed claims for services rendered which, for each of those dates, would entail Gross spending more time than his typical workday. In many instances involving his nursing home, MHMR and office patients, Gross upcoded claims for services for patients with whom he actually had contact. Upcoding is a fraudulent practice in which a provider claims a higher level CPT procedure code than was actually performed, resulting in a higher payment to the provider.
Gross, in numerous instances involving his nursing home patients, filed claims for services on dates he did not actually see the patients. In those instances, the patient may have been present at the nursing home at the time of his visit, or the patient may have died or been discharged before Gross’ visit.
Counts one through five of the indictment allege that Gross submitted claims to Medicaid and Medicare for services allegedly rendered on days in April and May 2014, to patients at MHMR and nursing home facilities, which Gross could not have rendered during the limited amount of time he was at the facilities.
Count six alleges that on March 20, 2013, Gross submitted a claim to Medicaid and Medicare for services allegedly rendered to a patient at a nursing home in San Angelo on the patient’s actual date of death, when, in fact, the patient had been discharged from the nursing home the previous day and admitted to the hospital where the patient died.
Counts seven through 52 allege that on various dates ranging from March 26, 2009, to July 20, 2012, Gross submitted claims to Medicare and Medicaid for services allegedly rendered after patients had died.
An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. If convicted, however, each of the 52 counts of health care fraud carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine. Restitution could also be ordered. In addition, the indictment includes a forfeiture allegation that would require Gross, upon conviction, to forfeit: 1) at least $1.75 million in a money judgment for the proceeds traceable to the commission of each offense; 2) approximately $3 million in cash seized from various bank accounts in San Angelo and in Ft. Washington, Pennsylvania, as well as from T. Rowe Price accounts; and 3) three parcels of real estate in San Angelo and Rockport, Texas.
The Federal Bureau of Investigation, Health and Human Services Office of Inspector General, and Medicaid Fraud Control Unit, Office of the Texas Attorney General are investigating. Assistant U.S. Attorney Ann Cruce-Haag is handling the prosecution, and Assistant U.S. Attorney John de la Garza is handling the forfeiture.