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Baton Rouge doctor to pay $43.5 million restitution for fraud

We assume Louisiana doctors are skilled and knowledgeable, but that doesn't make them smart business people. Some doctors with their own offices and clinics depend heavily upon others to handle the "business end," including Medicaid and Medicare billing, so physicians can concentrate on patient care. Doctors trust these vital employees as much as workers trust medical professionals to follow legal guidelines.

A psychiatrist involved with three mental health clinics, including two in Baton Rouge, was sentenced recently after pleading guilty to charges of Medicare fraud. Prosecutors said the doctor was among a group of employees at Serenity Center of Baton Rouge, Shifa Community Mental Health Center and an out-of-state facility who defrauded the government over a period of about seven years.

The defendant, the co-owner of two of the mental health centers, was one of 17 people convicted in the alleged fraud scheme. Other owners also were convicted, along with members of the facilities' administration and even therapists.

Prosecutors said the 56-year-old defendant and others who worked with him sent $258 million in fraudulent claims to Medicare. The government shelled out more than $43 million for those claims, for which the defendant was ordered to pay restitution. The doctor also was sentenced to seven years of imprisonment.

The government, which spent three years investigating the activities at the mental health facilities, argued the psychiatrist charged Medicare for services patients didn't need. Some patients reportedly were placed and kept in inappropriate psychiatric programs just to jack up the government billing. Prosecutors also asserted patients' records were altered to show services were rendered but were never provided.

A fraud charge may be the result of a crime or an error. For a defendant, everything – freedom, financial security and reputation -- is riding on the truth. Sometimes, the only person who can prove a mistake was made, rather than a crime, is a criminal defense attorney.

Source: The Times-Picayune, "Baton Rouge psychiatrist sentenced to 7 years in prison for role in $258 million Medicare scheme" Quincy Hodges, Aug. 25, 2014

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