Hospital administrator sentenced to 40 years in prison for Medicare Fraud

In what is considered the longest sentence of its kind to date, a federal judge has sentenced an assistant administrator at a Houston hospital to 40 years in prison and ordered him to pay $31 million in restitution for his role in a plan that fraudulently charged Medicare $116 million for mental health and substance abuse treatments. Because the administrator Mohammed Khan is 65 the sentence is considered the equivalent of a death sentence.

Khan pleaded guilty in 2012 to conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and paying illegal kickbacks after charging Medicare $116 million over four years for unnecessary services by Riverside General Hospital.

To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme.

According to admissions made in connection with Khan’s guilty plea, from January 2008 through February 2012, Khan and others at Riverside General Hospital operated a scheme to defraud Medicare by submitting claims for PHP services that were not medically necessary and, in some cases, never provided. Prior to Khan’s arrest, Riverside submitted over $116 million in claims to Medicare for PHP services purportedly provided to the recruited beneficiaries, when in fact, the PHP services were medically unnecessary or never provided. Khan also admitted that he and his co-conspirators paid kickbacks to patient recruiters and to owners and operators of group care homes in exchange for which those individuals delivered ineligible Medicare beneficiaries to the hospital’s PHPs.

Others involved in the fraudulent scheme already have pleaded guilty and are awaiting sentencing. Earnest Gibson III, the former president of Riverside; his son, Earnest Gibson IV, who operated a Riverside PHP; Regina Askew, a patient file auditor and group home operator; and Robert Crane, a patient recruiter, were all convicted after jury trial in November 2014 and await sentencing. William Bullock, an operator of a Riverside satellite location, as well as Leslie Clark, Robert Ferguson, Waddie McDuffie and Sharonda Holmes, who were involved in paying or receiving kickbacks, also have pleaded guilty to their roles in the scheme.

Jeffrey Newman represents whistleblowers