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Wednesday, June 12, 2024 | Back issues
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Two Headed to Prison for $258.5M Medicare Fraud

(CN) - The owner of a community mental health centers in Baton Rouge, La., and a patient recruiter for a center in Houston were sentenced to prison today for engaging in a $258.5 million Medicare fraud scheme.

Roslyn Dogan, 53, of Baton Rouge, and James Hunter, 48, of Houston, were found guilty after a six day trial in May of conspiracy to commit health card fraud. Dogan was also convicted of two counts of health care fraud, while Hunter was also convicted of a charge of conspiracy to pay and receive kickbacks.

This morning in Baton Rouge, Chief U.S. District Judge Brian A. Jackson sentenced Dogan to 90 months in prison and ordered her to pay $43.5 million in restitution.

Hunter was then sentenced to 60 months in prison, and ordered to pay $3.2 million in restitution.

According to federal prosecutors, Dogan, co-owner of Serenity Center of Baton Rouge, and a manager and marketer for two other facilities in the city, recruited Medicare beneficiaries who were living in nursing homes and assisted living facilities to attend unnecessary psychotherapy programs.

The government said Dogan then devised schemes to keep the patients at the facilities for as long as possible without invoking scrutiny from Medicare. These included having patients involuntarily committed to local inpatient psychiatric hospitals and then discharged and re-admitted to one of her facilities.

Prosecutors also accused Dogan of directing staff at the Baton Rouge facilities to falsify treatment records indicating that patients had received psychotherapy treatment when, in fact, the patients had not received such treatment.

To cover her tracks, prosecutors said Dogan intercepted patients' mail so that they could not see what services were billed to their names, and she even stole incriminating documents from federal custody.

As for Hunter, evidence presented at trial showed that he agreed to recruit Medicare beneficiaries to attend unnecessary psychotherapy sessions at Shifa Community Mental Health Center in Houston in exchange for $1,500 per week in cash.

Prosecutors said in some instances Hunter paid Medicare recipients from group homes $75 a week to attend the sessions

To ensure their admittance to the program, Hunter instructed each beneficiary on what to say to physicians regarding their supposed psychiatric symptoms. As a result of the kickback scheme with Hunter, the Houston facility billed Medicare approximately $16.5 million, prosecutors said.

According to court documents, the investigation into the three community mental health centers has resulted in the conviction of seventeen individuals, including therapists, marketers, administrators, owners and a medical director.

The companies collectively submitted more than $258 million in claims to Medicare for unnecessary psychotherapy services over a period of seven years. Medicare paid approximately $43.5 million on those claims.

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