Louisiana Psychiatrist and Five Others Sentenced in $258 Million Medicare Fraud Scheme
BATON ROUGE, LA—A Louisiana psychiatrist was sentenced in federal court in Baton Rouge yesterday to serve 86 months in prison for his role in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric services.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney J. Walter Green of the Middle District of Louisiana, Special Agent in Charge Mike Fields of the Dallas Region of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division and Louisiana State Attorney General James Buddy Caldwell made the announcement.
ZAHID IMRAN, M.D., 56, of Baton Rouge, pleaded guilty on May 13, 2014, to count one in a superseding indictment charging him with conspiracy to commit health care fraud. In addition to his prison term, IMRAN was sentenced to serve two years of supervised release and ordered to pay $23.8 million in restitution, jointly and severally with his conspirators. IMRAN will also be ordered to forfeit an additional $23.8 million as illegal proceeds of the fraudulent scheme.
According to documents filed in the case, in 2011 law enforcement opened an investigation into three community mental health centers—Shifa Community Mental Health Center of Baton Rouge (Shifa), Serenity Center of Baton Rouge (Serenity) and Shifa Community Mental Health Center of Texas (Shifa Texas)—and has resulted in 17 convictions of individuals employed by the facilities, including therapists, marketers, administrators, owners and the medical director. The companies billed Medicare for partial hospitalization program services for the mentally ill that were unnecessary or never provided over a period of approximately seven years. The companies, collectively, submitted more than $258 million in claims to Medicare for partial hospitalization program services during this period. Medicare paid approximately $43.5 million on those claims.
IMRAN served as Shifa’s medical director and co-owner of Serenity Center and Shifa Texas. As part of the scheme, IMRAN would admit mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization. IMRAN would then re-certify these patients’ appropriateness for the program, in an effort to continue to bill Medicare for services. To support the fraudulent Medicare billing, IMRAN and others would falsify patient treatment records to reflect services on dates where no such services were provided.
IMRAN’s lengthy sentence follows the sentences imposed last week on five other defendants in the case, including several recreational therapists and an office administrator. Last week, Chief U.S. District Court Judge Brian A. Jackson sentenced the individuals as follows:
• SEDRA J. SIGNATER, age 48, of Baton Rouge, Louisiana. According to court documents, from 2008 forward, SIGNATER worked as an administrator at Shifa. On numerous occasions, SIGNATER would falsify documents, including patient records, group progress notes, and other medical documentation, to make it appear as though Shifa social workers had provided services and/or treatments to patients, despite the fact that the treatments had not been provided. On August 21, 2014, SIGNATER was sentenced to three-year term of imprisonment, a two-year term of supervised release following his release from imprisonment, and restitution in the amount of $23.8 million.
• ROBERT E. BOOKER, age 35, JUNE M. DURIO, age 50, JAMES J. MYER, age 42, and NANCY N. REED, age 45, all of Baton Rouge. At the direction of their supervisors, BOOKER, DURIO, MYER, and REED knowingly participated in the falsification of documents, including patient records, group progress notes, and other medical documentation, so that their supervisors could use the false documents to support false claims to Medicare. On August 22, 2014, each defendant was sentenced to serve a two-year term of probation.
The case is being investigated by HHS-OIG, the FBI and the Medicaid Fraud Control Unit of the Louisiana Attorney General’s Office, 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 Middle District of Louisiana. The case is being prosecuted by Trial Attorneys Abigail Taylor and Dustin M. Davis of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shubhra Shivpuri of the Middle District of Louisiana.
U.S. Attorney Green stated: “This case illustrates the enormity of this country’s healthcare fraud epidemic which is estimated to cause tens of billions of dollars in financial losses each year. In addition to financial losses, such fraud exposes patients to unnecessary medical treatments and compromises the integrity of their medical records by falsifying their medical status, treatments, and other important information. My great appreciation to the prosecutors and agents who worked tirelessly on this important matter. We will continue to devote the necessary resources to track down and aggressively pursue those who engage in health care fraud.”
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and 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.