The two physician owners of a Houston-area mental health clinic were sentenced yesterday, January 12, 2015, to 148 months and 120 months respectively for their roles in a $97 million Medicare fraud scheme. A group home owner who sent residents to the clinic in exchange for kickbacks was also sentenced to 54 months in prison for her role.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge Mike Fields of the U.S. Department of Health & Human Services-Office of the Inspector General (HHS-OIG) Dallas Regional Office, the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU), Special Agent in Charge Joseph J. Del Favero of the Railroad Retirement Board-Office of Inspector General (RRB-OIG) Chicago Field Office and Inspector General Patrick E. McFarland of the Office of Personnel Management-Office of Inspector General (OPM-OIG) made the announcement.
“Doctors are not only bound by oath to serve the health of their patients, they are bound by duty to serve as gatekeepers for Medicare spending,” said Assistant Attorney General Caldwell. “In this case, without the criminal participation of Drs. Sanjar and Sajadi, this fraud simply could not have happened.”
Physicians Mansour Sanjar, 81, and Cyrus Sajadi, 67, the owners of Spectrum Care P.A., a community mental health clinic, were each convicted following a jury trial on March 12, 2014, of conspiracy to commit health care fraud and conspiracy to pay and receive kickbacks, as well as related counts of health care fraud and paying illegal kickbacks. Chandra Nunn, 36, a group home owner, was convicted of conspiracy to commit health care fraud and conspiracy to pay and receive kickbacks, as well as related counts of receiving illegal kickbacks. In addition to the prison sentences, U.S. District Judge Vanessa D. Gilmore of the Southern District of Texas ordered Sanjar and Sajadi to pay $8,058,612.39 in restitution, and Nunn to pay $1,885,667.41 in restitution. Co-defendants Adam Main, Shokoufeh Hakimi, Sharonda Holmes and Shawn Manney were also convicted and are scheduled to be sentenced on Jan. 20, 2015.
According to evidence presented at trial, Sanjar and Sajadi orchestrated and executed a scheme to defraud Medicare beginning in 2006 and continuing until their arrest in December 2011. Sanjar and Sajadi owned Spectrum, which purportedly provided partial hospitalization program (PHP) services. A PHP is a form of intensive outpatient treatment for severe mental illness. The Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services.
Evidence presented at trial showed that Sanjar and Sajadi signed admission documents and progress notes certifying that patients qualified for PHP services, when in fact, the patients did not qualify for or need PHP services. Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games, which are not activities covered by Medicare.
Evidence presented at trial also showed that Sanjar and Sajadi paid kickbacks to group care home operators and patient recruiters, including Nunn, Holmes and Manney, in exchange for delivering ineligible Medicare beneficiaries to Spectrum. In some cases, the patients received a portion of those kickbacks. According to evidence presented at trial, Spectrum billed Medicare for approximately $97 million in services that were not medically necessary and, in some cases, not provided.
The case was investigated by the FBI, HHS-OIG, Texas MFCU, RRB-OIG and OPM-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas. The case is being prosecuted by Assistant Chief Laura M.K. Cordova, Senior Trial Attorney Jonathan T. Baum and Trial Attorney William S.W. Chang of the Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.