7 for 7: Jury Convicts All Defendants in $97 Million Medicare Fraud

7 for 7: Jury Convicts All Defendants in $97 Million Medicare Fraud

 A federal jury in Houston has convicted two owners of a former Houston mental health care company, Spectrum Care P.A., several of its employees, and the owners of certain Houston group care homes for their participation in a $97 million Medicare fraud.

Physicians Mansour Sanjar and Cyrus Sajadi, the owners of Spectrum, each were convicted of conspiracy to commit health care fraud and conspiracy to pay kickbacks as well as related counts of health care fraud and paying illegal kickbacks.  Adam Main, a physician’s assistant, was convicted of conspiracy to commit health care fraud and related counts of health care fraud.  Shokoufeh Hakimi, administrator of Spectrum, was convicted of conspiracy to commit health care fraud, conspiracy to pay kickbacks and a related count of paying an illegal kickback.   Chandra Nunn, a group home owner, also was convicted of conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and related counts of receiving illegal kickbacks.   Sharonda Holmes, a patient recruiter, was convicted of conspiracy to pay and receive kickbacks and a related count of receiving an illegal kickback.   Shawn Manney, a group home owner, was convicted of conspiracy to pay and receive illegal kickbacks.

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.  Prosecutors contended that the Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services.  Sanjar, Sajadi, Main and Moore 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, according to the government.  The government also contended that Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games–activities that are not covered by Medicare.

Evidence presented at trial showed that Sanjar, Sajadi, and Hakimi paid kickbacks to Nunn, Holmes, Manney and other group care home operators and patient recruiters in exchange for delivering ineligible Medicare beneficiaries to Spectrum.  In some cases, the patients received a portion of those kickbacks, according to the evidence. 

According to evidence presented at trial, Spectrum billed Medicare for approximately $97 million in services that were not medically necessary and, in some cases, were not provided.

 Contact the author at smeyerow@optonline.net

For more information about LexisNexis products and solutions connect with us through our corporate site.