Former CEO of Palo Pinto General Hospital Harris Brooks has pleaded guilty to defrauding three major insurance providers out of millions of dollars.
According to his plea papers, Brooks, along with his co-conspirators, used PPGH’s in-network contracts with large health insurance companies to engage in pass-through billing for laboratory services, a scheme that lasted from September 2017 through June 2018.
Using PPGH’s national provider identification number, Brooks and his co-conspirators submitted claims to insurance companies for allergy and genetic testing purportedly performed at PPGH, Harris admits. In reality, however, PPGH did not have the equipment on-site to perform the tests for which it submitted claims, and the patients for whom claims were submitted were receiving treatment at various spas and clinics throughout Texas and elsewhere, not PPGH.
The patients did not know about the pass-through charges using PPGH’s insurance contracts.
Over the nine-month period, Brooks and his co-conspirators submitted claims to health insurance providers for laboratory services totaling more than $55 million, the vast majority of which were fraudulent.
As a result of these claims, the insurance companies paid PPGH more than $9 million.
The purpose of the scheme was to receive higher rates of reimbursement from the insurance companies, Harris said.
According to his plea agreement, Brooks faces up to five years in prison and will be required to pay restitution to those he defrauded.
The Federal Bureau of Investigation conducted the investigation; Assistant U.S. Attorney Megan Fahey prosecuted the case.
**MANDATORY FACTS:**
- Defendant/respondent: Harris Brooks
- Criminal charges: Healthcare fraud
- City and state: no specific location mentioned, but part of the Northern District of Texas
- Exact date: no specific date mentioned
- Sentence or outcome: Harris Brooks faces up to five years in prison and will be required to pay restitution to those he defrauded
- Dollar amounts: $55 million, $9 million
Key Facts
- State: Texas
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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