Former Texas Hospital CEO Pleads Guilty To Defrauding Health Care Insurers

Submitting false claims, accepting kickbacks and prescribing unnecessary medications – these and many other crimes all fall under the umbrella of health care fraud. The Allegiant Experts Blog has covered many a story detailing the actions of various fraudsters who have participated in one or all of the above mentioned offenses. This week, we profile another.

The former CEO of Mineral Wells, Texas-based Palo Pinto General Hospital, Brooks has recently pleaded guilty to defrauding three different health care insurers. As John Commins of HealthLeaders reports, based on a recent Department of Justice news release, Harris and a group of co-conspirators conducted a pass-through billing scheme involving laboratory services. Over the course of nine months, Brooks submitted claims that totalled over $55 million. Most of the claims were fraudulent.

Using PPGH’s national provider ID to submit false
 claims for lab work, Brooks was able to secure the hospital more than $9
 million. He made use of the PPGH’s in-network contracts with BlueCross
 BlueShield of Texas, CIGNA Texas, and United Healthcare to swindle the insurers
 out of the money.

“Using PPGH’s national provider identification
 number, Brooks and his co-conspirators submitted claims to the insurance
 companies for allergy and genetic testing purportedly performed at PPGH,”
 Commins reports, “In reality however, PPGH did not have the equipment on-site
 to perform the tests for which it submitted claims, and the patients for whom
 claims were submitted were receiving treatment at various spas and clinics
 throughout Texas and elsewhere, not PPGH, the plea agreement states.”

He goes on to note that the patients were unaware of
 any pass-through charges using PPGH’s insurance contracts. The nine-month
 period within which Brooks and his co-conspirators submitted their false claims
 took place between September 2017 and June 2018. As part of his plea agreement,
 Brooks admitted that he unfolded his scheme for the purpose of receiving higher
 reimbursements from the insurers.

It is clear that Brooks’ scheme is especially
 frowned upon by his former hospital. PPGH’s mission statement and vision do not
 differ greatly from those of other hospitals. The hospital is “dedicated to
 promoting optimal health and well being of the entire community by providing
 patient and family centered, quality healthcare in a respectful and safe
 environment,” according to its website.

However, it is worth noting that being ethical is
 the top core value listed on their website. Honesty and integrity are also
 listed as core values in addition to being trusted and patient and family
 focused. Evidently, Brooks didn’t genuinely respect the PPGH’s core values. He
 now faces up to five years in prison and will be required to pay restitution to
 every insurer he and his team defrauded.
 

Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help your case. Our experts have been providing expert clinical services for nearly two decades and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.

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