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September 11, 2015

Jury Convicts Houston Psychiatrist in $158 Million Medicare Fraud Scheme

WASHINGTON—A Houston psychiatrist was convicted late yesterday by a federal jury of participating in a $158 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 C.J. Porter U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) Dallas Region, the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) and Special Agent in Charge D. Richard Goss of the Internal Revenue Service-Criminal Investigation Division (IRS-CI) Houston Field Office made the announcement.

Sharon Iglehart, 58, of Harris County, Texas, was convicted of one count of conspiracy to commit health care fraud, one count of health care fraud and three counts of making false statements relating to health care matters, following a seven-day jury trial before U.S. District Judge Ewing Werlein Jr. of the Southern District of Texas. Iglehart is scheduled to be sentenced on Dec. 5, 2015.

According to evidence presented at trial, from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital (Riverside), approximately $158 million in false and fraudulent claims for partial hospitalization program (PHP) services to Medicare. A PHP is a form of intensive outpatient treatment for severe mental illness.

The evidence presented at trial showed that the Medicare beneficiaries for whom Riverside billed Medicare did not receive PHP services. In fact, according to evidence presented at trial, most of the Medicare beneficiaries for whom Riverside billed Medicare rarely saw a psychiatrist and did not receive intensive psychiatric treatment.

In addition, evidence presented at trial showed that Iglehart personally billed Medicare for individual psychotherapy and other treatment to patients at Riverside locations—treatment that she never provided. The evidence at trial also demonstrated that Iglehart falsified the medical records of patients at Riverside’s inpatient facility to make it appear as if she provided psychiatric treatment when, in fact, she did not.

To date, 12 others previously have been convicted of offenses based on their roles in the fraudulent scheme. Earnest Gibson III, the former president of Riverside; Earnest Gibson IV, the operator of one of Riverside’s PHP satellite locations; Regina Askew, a group home owner and patient file auditor; and Robert Crane, a patient recruiter, were all convicted after a jury trial in October 2014. Earnest Gibson III was sentenced to 45 years in prison. Earnest Gibson IV was sentenced to 20 years in prison. Regina Askew was sentenced to 12 years in prison. Robert Crane has not yet been sentenced. Mohammad Khan, an assistant administrator at the hospital, who managed many of the hospital’s PHPs, pleaded guilty and was sentenced to 40 years in prison. William Bullock, an operator of a Riverside satellite location, as well as Leslie Clark, Robert Ferguson, Waddie McDuffie and Sharonda Holmes, who were all involved in paying or receiving kickbacks, also pleaded guilty. Bullock, Clark and Ferguson await sentencing.

The case was investigated by the FBI, HHS-OIG, Texas MFCU, and IRS-CI with assistance from the Railroad Retirement Board-Office of Inspector General (RRB-OIG) Chicago Field Office and the Office of Personnel Management-Office of Inspector General, 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 Assistant Chief Laura M.K. Cordova and 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 more than 2,300 defendants who have collectively billed the Medicare program for more than $7 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

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

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