Earnest Gibson III, Medicare Fraud, Texas 2012

Former Hospital President and Son Convicted in $158 Million Medicare Scheme

A federal jury in Houston, Texas, today convicted the president of Riverside General Hospital, his son, and two others for their participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.

The convicted defendants, including 70-year-old Earnest Gibson III, the former president of Riverside General Hospital, and his 37-year-old son Earnest Gibson IV, the operator of one of Riverside's satellite locations, as well as Regina Askew, 49, a group home owner, and Robert Crane, 58, a patient recruiter, were found guilty of conspiracy to commit health care fraud and conspiracy to pay kickbacks, as well as related counts of paying and receiving illegal kickbacks. Gibson III and Gibson IV were also convicted of conspiracy to commit money laundering.

The scheme, which began in 2005 and continued until June 2012, involved the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through the hospital. A PHP is a form of intensive outpatient treatment for severe mental illness. The Medicare beneficiaries for whom Riverside and its satellite locations billed Medicare for PHP services did not qualify for or need PHP services.

Evidence presented at trial demonstrated that the Medicare beneficiaries rarely saw a psychiatrist and did not receive intensive psychiatric treatment. Some of the Medicare beneficiaries were suffering from Alzheimer's and could not actively participate in any treatment even if they actually qualified to receive PHP services. Nevertheless, Gibson III, Gibson IV, and Askew submitted claims for reimbursement to Medicare claiming that PHP services were provided to the Medicare beneficiaries.

Earnest Gibson III paid kickbacks to patient recruiters and to owners and operators of group care homes, including Askew, in exchange for those individuals delivering ineligible Medicare beneficiaries to the hospital's PHPs. Gibson IV also paid patient recruiters, including Crane and others, in exchange for those individuals delivering ineligible Medicare beneficiaries to the specific PHP operated by Gibson IV.

Approximately $158 million in claims to Medicare were submitted for PHP services purportedly provided by the hospital to the recruited patients. The defendants caused the submission of these false and fraudulent claims to Medicare, resulting in significant financial losses for the government.

The verdict sends a powerful message that the government will hold accountable anyone who seeks personal profits at the expense of America's most vulnerable citizens. The scheme targeted mentally ill and disabled Americans, treating them as commodities to be traded and cashed out for personal gain.

Ten defendants have now been convicted in connection with the Riverside fraud scheme. The government will continue to pursue those responsible for this massive healthcare fraud scheme.

Mandatory Facts: Defendant name: Earnest Gibson III, Earnest Gibson IV, Regina Askew, Robert Crane. Criminal charges: Conspiracy to commit health care fraud, conspiracy to pay kickbacks, paying and receiving illegal kickbacks, conspiracy to commit money laundering. City and state: Houston, Texas. Exact date: June 2012. Sentence or outcome: Convicted. Dollar amounts: $158 million.

Source: https://www.justice.gov/archives/opa/pr/president-houston-hospital-and-three-others-convicted-158-million-medicare-fraud-scheme