Dive Brief:
- The former president of Houston, TX-based Riverside General Hospital, Earnest Gibson III, will serve 45 years in prison for billing Medicare $158 million for mental health services that were never provided or deemed unnecessary. His son will also serve 20 years and Regina Askew, a group-home owner, will serve 12 years.
- Charges included conspiracy to commit healthcare fraud and pay kickbacks as well as money laundering, according to a release by the U.S. Justice Department. They must also pay restitution ranging from close to $7 million (Gibson III and Gibson IV) to more than $46 million (Askew).
- The group billed Medicare for services enrollees did not need or quality for between 2005 and 2012. Several suffered from Alzheimer's, eliminating them from participation in treatment.
Dive Insight:
Fraud costs the government between $60 billion to $90 billion every year, despite federal laws like the False Claims Act and the Anti-Kickback Statute.
But the administration is ramping up its efforts to crack down on fraud: Last month, CMS said it wants to launch the Provider Compliance Reporting System to track enforcement actions against Medicare providers over questionable claims, according to an article in Modern Healthcare. "The CMS needs a system that will allow Medicare review contractors and CMS staff to view a provider profile," the agency said in a notice.
Want to read more? You may want to read this story about the CMS crackdown on use of ambulances for non-emergent transport.