Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Tuesday, September 4, 2018
Houston Psychiatrist Sentenced to More Than 12 Years in Prison for Role in $155 Million Medicare Fraud Scheme
A 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 announcement.
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 showed.
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.
Topic(s):
Health Care Fraud
Component(s):
Criminal - Criminal Fraud Section
Federal Bureau of Investigation (FBI)
Press Release Number:
18-1140
Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Tuesday, August 23, 2016
Justice Department Sues Georgia for Unnecessarily Segregating Students with Disabilities
The Lawsuit is the First Challenge to a State-Run School System for Segregating Students with Disabilities
The Justice Department announced today that it has filed a lawsuit against the state of Georgia alleging that its treatment and segregation of students with disabilities in the Georgia Network for Educational and Therapeutic Support (GNETS) Program violates the Americans with Disabilities Act (ADA).
The lawsuit, filed in U.S. District Court for the Northern District of Georgia, alleges that Georgia’s administration of its mental health and therapeutic educational services for students with behavior-related disabilities unnecessarily segregates students with disabilities in GNETS when they could appropriately be served with their peers in general education settings. The community integration mandate of the ADA and the Supreme Court’s decision in Olmstead v. L.C. require states to make services available to people with disabilities – including children with behavioral disabilities – in the most integrated setting appropriate to their needs. The department’s complaint seeks declaratory and injunctive relief.
Approximately 4,600 students with disabilities are currently in GNETS. In July 2015, the department issued an extensive findings letter, notifying the state that it was violating the ADA by unnecessarily providing mental health and therapeutic educational services to students with behavior-related disabilities in segregated settings, denying them opportunities for meaningful interaction with their peers without disabilities. The department found that most students in GNETS spend their entire school day, including meals, exclusively with other students with disabilities. Specifically, more than two-thirds of GNETS students are assigned to attend school in regional GNETS centers that exclusively serve students with disabilities in buildings that are often located far from students’ homes. Other students are assigned to regional GNETS classrooms located within general school buildings, but often in separate wings or isolated sections of the buildings.
“Seventeen years ago, the Supreme Court made clear that states must serve people with disabilities, including children with disabilities, in the most integrated setting appropriate to their needs,” said Principal Deputy Assistant Attorney General Vanita Gupta, head of the Justice Department’s Civil Rights Division. “Georgia has relegated thousands of students with behavior-related disabilities to separate, segregated and unequal settings, and placed other students at serious risk of entering such settings, failing to comply with the Americans with Disabilities Act. The Justice Department seeks to make the promise of community integration a reality for all of the state’s students. Students with disabilities in Georgia are entitled to access the services and supports that they need in the most integrated setting appropriate, where they can interact with and learn alongside their non-disabled peers and access educational opportunities that are equal to those available to other students.”
“This complaint alleges that many children in the GNETS Program are consigned to dilapidated buildings that were formerly used for black children during segregation, or to classrooms that are locked apart from mainstream classrooms, with substantially fewer opportunities of participating in extracurricular activities like music, art and sports,” said U.S. Attorney John A. Horn of the Northern District of Georgia. “The law mandates that all children, including those with behavior-related disabilities, must have equal opportunities for education, and several existing programs within our Georgia schools show that with appropriate support and services, these students can enjoy far greater integration with their peers.”
The lawsuit further alleges that as a result of the state’s unnecessary segregation, students in GNETS lack equal access to academic and extracurricular opportunities enjoyed by their peers outside the GNETS Program. Mental health and therapeutic educational services and supports are available in Georgia to a limited number of students with disabilities in integrated educational settings. The students who receive such services, many of whom have disabilities similar to GNETS students, are able to interact to the fullest extent possible with their non-disabled peers, participate in curriculum that corresponds to appropriate grade-level standards and partake in a wide range of extracurricular activities.
The ADA prohibits discrimination on the basis of disability by public entities, including state and local governments. The ADA requires public entities to ensure that individuals with disabilities are provided services in the most integrated setting appropriate to their needs. The Justice Department’s Civil Rights Division enforces the ADA, which authorizes the Attorney General to investigate allegations of discrimination based upon disability and to conduct compliance reviews regarding the programs and services offered by public entities. Visit www.ada.gov and www.justice.gov/crt to learn more about the ADA and other laws enforced by the Civil Rights Division. For more information on the Civil Rights Division’s Olmsteadenforcement, please visit: www.ada.gov/olmstead/.
Topic(s):
Civil Rights
Component(s):
Civil Rights - Educational Opportunities Section
Press Release Number:
16-968
Updated August 23, 2016