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May 6, 2015

Houston Doctor and Group Home Owner Indicted for Alleged Roles in $5.2 Million Medicare Fraud Scheme

A Houston doctor and a group home owner were arrested on charges related to their alleged participation in a $5.2 million Medicare fraud scheme involving false claims for mental health treatment.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge Lucy R. Cruz of the Internal Revenue Service-Criminal Investigation’s (IRS-CI) Houston Field Office, the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) and Special Agent in Charge Mike Fields of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office made the announcement.

Walid H. Hamoudi, M.D., 63, of Houston, and Geraldine J. Caroline, 49, of Houston, were each charged with one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks and five counts of paying and receiving kickbacks. The indictment also charges Hamoudi with one count of money laundering. Both defendants are expected to make their initial appearances in federal court in Houston today.

According to the indictment, Hamoudi and Caroline allegedly participated in a scheme to defraud Medicare beginning in 2010 and continuing until June 2011. The defendants allegedly caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services—a form of intensive outpatient treatment for severe mental illness—to Medicare through a Houston hospital. Hamoudi allegedly paid Caroline kickbacks to send her group home residents to the hospital to receive PHP services even though the patients did not qualify for or receive the services.

The indictment alleges that the defendants and their co-conspirators submitted or caused to be submitted approximately $5.2 million in claims to Medicare and over $380,000 in claims to Medicaid for PHP services purportedly provided by the hospital, when, in fact, the PHP services were medically unnecessary or never provided.

In February 2012, Mohammad Khan, an assistant administrator at the hospital, who managed many of the hospital’s PHPs, pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay illegal kickbacks and five counts of paying illegal kickbacks for his role in the scheme. Khan is scheduled to be sentenced on May 21, 2015.

In October 2014, Earnest Gibson III, the president of the hospital, along with his son Earnest Gibson IV, Regina Askew and Robert Crane, were convicted for their roles in the scheme. William Bullock III, Robert Ferguson, Waddie McDuffie, Sharonda Holmes and Leslie Clark have pleaded guilty for their roles in the scheme. These defendants have not yet been sentenced.

The charges contained in an indictment are merely accusations, and a defendant is presumed innocent unless and until proven guilty.

This case was investigated by the FBI, IRS-CI, HHS-OIG and the MFCU, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas. The case is being prosecuted by Trial Attorney Ashlee C. McFarlane of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.

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