Houston psychiatrist was sentenced today to 150 months in prison for
his role in a $155 million Medicare fraud scheme involving false and
fraudulent claims for psychiatric services.
Assistant Attorney General Brian A. Benczkowski of the
Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick 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 of the U.S. Department of Health and Human Services-Office of
Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge D.
Richard Goss of IRS Criminal Investigation’s (IRS-CI) Houston Field
Office, Special Agent in Charge Kristin Osswald of the Railroad
Retirement Board Office of Inspector General’s (RRB-OIG) Chicago
Regional Office, and Unit Division Chief Stormy Kelly of the Texas
Attorney General’s Medicaid Fraud Control Unit (MFCU) made the
Riyaz Mazcuri, 67, a former attending psychiatrist at
Riverside General Hospital (Riverside) of Houston, was sentenced by U.S.
District Judge Vanessa D. Gilmore of the Southern District of Texas.
Judge Gilmore also ordered Mazcuri to pay $20,607,410.22 in restitution
to Medicare and $2,250,789.69 in restitution to Medicaid.
On May 23, 2017, following a five-day trial, a jury
convicted Mazcuri of one count of conspiracy to commit health care
fraud, and five counts of health care fraud.
According to the evidence at trial, from 2006 until
February 2012, Mazcuri and others engaged in a scheme to defraud
Medicare by submitting to Medicare, through Riverside, approximately
$155 million in false and fraudulent claims for partial hospitalization
program (PHP) services. A PHP is a form of intensive outpatient
treatment for patients with severe mental illness.
In addition, evidence presented at trial showed that
Mazcuri indiscriminately admitted and readmitted patients into these
intensive psychiatric programs – often for years on end – many of whom
suffered from severe Alzheimer’s or dementia and were unable to
participate in the treatment purportedly provided at the PHPs, and who
therefore did not qualify for the services. Evidence also showed that
Mazcuri falsified medical records and signed false documents to make it
appear as if patients admitted to the PHPs qualified for, required, and
actually received the intensive psychiatric services.
Evidence also demonstrated that Mazcuri personally
billed Medicare for psychiatric treatment he purportedly provided to
Riverside’s PHP patients – treatment he never actually provided.
Mazcuri’s signature on patient documents enabled Riverside to bill
Medicare for over $55 million of the total $155 million that Riverside
billed Medicare for fraudulent psychiatric services, the evidence
To date, 15 others have been convicted of offenses
based on their roles in the fraudulent scheme, including Earnest Gibson
III, 73, the former president of Riverside; Earnest Gibson IV, 41, the
operator of one of Riverside’s PHP satellite locations; Regina Askew,
53, a group home owner and patient file auditor; and Robert Crane, 61, a
patient recruiter, all of whom were 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, 68, an assistant administrator at the
hospital, who managed many of the hospital’s PHPs, pleaded guilty and
was sentenced to 40 years in prison. Sharon Iglehart, 61, a physician,
was also convicted after a jury trial in August 2015. She was sentenced
to 12 years in prison. Walid Hamoudi, 66, a physician, pleaded guilty
in August 2015. He was sentenced to five years in prison.
The case was investigated by the FBI, HHS-OIG and
IRS-CI with assistance by RRB-OIG and MFCU. The case was prosecuted by
former Assistant Chief Ashlee Caligone McFarlane and Trial Attorneys
Aleza Remis and Kevin Lowell of the Criminal Division’s Fraud Section.
The Medicare Fraud Strike Force operations are part of a
joint initiative between the Department of Justice and HHS to focus
their efforts to prevent and deter fraud and enforce current anti-fraud
laws around the country. The Medicare Fraud Strike Force operates in 10
areas nationwide. Since its inception in March 2007, the Medicare
Fraud Strike Force has charged over 3,500 defendants who collectively
have falsely billed the Medicare program for over $12.5 billion.