Clinic Manager Guilty of Health Care Fraud
HOUSTON—The owner and operator of Elite P. Care Medical Services has been convicted of conspiracy to commit health care fraud and health care fraud in a $1 million fraud scheme, announced U.S. Attorney Kenneth Magidson. Verona Spicer, 46, pleaded guilty today before U.S. District Judge Kenneth Hoyt.
Spicer admitted that she hired a physician to sign patient medical documents at her clinic which had office locations on Harwin Drive in Houston and in Port Arthur. Spicer told the court that she filed Medicare and Medicaid enrollment applications in order for her to bill for services under the doctor’s Medicare and Medicaid provider numbers even though the physician did not see or evaluate the patients at Spicer’s clinic. Spicer admitted that a foreign medical graduate who did not have a license to practice medicine in the United States saw the patients, while the physician came in after hours to sign the patient medical records, including medical evaluations, physical therapy treatment notes and home health orders for patients she had not personally seen. Spicer also admitted to submitting claims for fraudulent physical therapy and diagnostic test claims. Pursuant to the plea agreement, Spicer has agreed to pay Medicare and Medicaid $508,868.70 in restitution.
Judge Hoyt has set sentencing for Jan. 11, 2016, at which time she faces up to 10 years in federal prison and a fine of up to a $250,000. She was permitted to remain on bond pending that hearing.
The investigation leading to the charges was conducted by Department of Health and Human Services – Office of Inspector General, FBI, the Texas Attorney General Office’s Medicaid Fraud Control Unit with the assistance of the Medicare Zone Program Integrity Contractor, Health Integrity LLC. Assistant U.S. Attorney Julie Redlinger is prosecuting the case.