Medical Billing Fraud


What happens when medical billing goes awry? The government and the tax payer is on the hook for bogus charges, as witnessed below…

After 30 years as CEO of one of Houston’s most historic hospitals, Earnest Gibson III, along with his son and five others, was arrested on Thursday – part a national Medicare fraud sweep involving $430 million in bogus billings and 91 health care providers in seven states.

If the allegations against the 68-year-old Gibson are true, that he and others at the hospital bilked the Medicare program of $158 million over a period of more than seven years, it could prove lethal for Riverside, once the primary hospital for the city’s black population.

Gibson and his son Earnest Gibson IV, 35, were charged with 13 counts: conspiracy to commit health care fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; one count of money laundering and ten counts of violating the anti-kickback statute.

They are among dozens of individuals who were arrested or surrendered Thursday as indictments were unsealed nationwide. The Gibsons are accused of teaming up with Riverside’s previously indicted assistant administrator, Mohammad Khan, who pleaded guilty in the scheme in February.

Together, the indictment alleges, the three created a plan that paid up to $3,200 in cash to “patient recruiters.” The recruiters, in turn, would pay Houston-area group-home owners to send patients to Riverside’s satellite clinics offering “partial hospitalization programs” for the mentally ill….

More at 91 Charged With $430 Million Medicare Billing Fraud – Kaiser

To that end, here’s an interesting video; a recent Public Citizen reports a greater number of incidences of pharmaceutical companies that are accused of defrauding Medicaid programs. Of course, that means state and federal government agencies then need to act against these companies to get the tax payer’s money back. It appears however, that “whistleblowers” – people in the know who reveal these frauds to the various governments, are eligible to receive 15-30% of the recovery amount obtained by the government….