If the Allegiant Experts Blog has proven anything, it’s that there is no area of the medical profession where health care fraud doesn’t occur. This, of course, is most unfortunate. The good news, however, is that no perpetrator of this crime is immune to doing serious jail time. As reported by the United States Department of Justice earlier this week, Riyaz Mazcuri is finding that out the hard way.

According to the report, the 67 year-old former psychiatrist was sentenced to 150 months in prison for this role in a $155 million Medicare fraud scheme. During his time as an attending psychiatrist at Riverside General Hospital in Houston, Mazcuri was accused of submitting false and fraudulent claims for psychiatric services to the national health insurance program.

Mazcuri’s long stretch in jail is not his only punishment.

In addition to his nearly 12 and a half year prison sentence, the Houston-based practitioner has also been ordered to pay $20,607,410.22 in restitution to Medicare and $2,250,789.69 in restitution to Medicaid. Mazcuri’s five-day trial concluded on May 23rd of last year. He was convicted of one count of conspiracy to commit health care fraud and five counts of health care fraud.

As the DOJ report explains, evidence presented at the trial showed that between 2006 and 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.”

Claims were submitted on behalf of ineligible patients.

In addition, the report reveals that evidence also showed that Mazcuri regularly admitted and readmitted patients into intensive psychiatric programs although they were unable to participate in the treatment provided at the PHPs. Therefore, did not qualify for the services. In many cases, these patients were admitted for years on end.

“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,” says the report, “Evidence also demonstrated that Mazcuri personally billed Medicare for psychiatric treatment he purportedly provided to Riverside’s PHP patients – treatment he never actually provided.”

As a result of Mazcuri’s continuous false and fraudulent claims, more than $55 million out of the total $155 million was billed to Medicare by Riverside. The Department of Justice reveals that, to date, 15 other people have also been convicted of offenses related to Mazcuri’s fraudulent scheme.

Mazcuri had several co-conspirators.

They include both Earnest Gibson III, who is the former president of Riverside and his son, Earnest Gibson IV who operated one of Riverside’s PHP satellite locations. Earnest Gibson III was sentenced to 45 years in prison while his son received a 20 year prison sentence. Another co-conspirator was Mohammad Khan, who was an assistant administrator at Riverside. It was his job to manage many of the hospital’s PHPs. After pleading guilty to his charges, he was sentenced to 40 years in prison.

Are you an attorney trying your own health care fraud case? If so, please don’t hesitate to contact Allegiant Experts to discover how we can help you. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.