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Fieldtrip For Fraud

Fieldtrip For Fraud

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

If the patients at Daybreak Rehabilitation Center didn’t need special programs to help with feeling anxious, overwhelmed, or depressed already, they will need it once they find out that they used to defraud Medicare millions of dollars. Daybreak was supposed to be a mental health clinic that helped patients heal. It ended up being a pretense more filing fraudulent health claims. Now Gwendolyn Gibbs, owner of the Daybreak Rehabilitation Center, is going to prison for lying about how sick her patients were and stealing from the U.S. taxpayer.

A Partial Hospitalization Program (PHP) is a form of intensive outpatient treatment for severe mental illness. None of the Daybreak patients, including individuals with intellectual disabilities, needed PHP services. Nevertheless, from 2007 until 2016, Gibbs admitted to falsifying medical records to make it appear that her patients were sicker than they actually were, in order to submit more than $15 million in fraudulent claims costing more than the services she was giving.

Gibbs also paid kickbacks to owners of group homes and patient recruiters in exchange for referring Medicare beneficiaries to Daybreak. The owners of the group homes required their residents to attend Daybreak and, in exchange, Gibbs and her co-conspirators provided transportation, supervision and meals to the group home residents. A win for everyone. Field trip for the patients. A day off for the group home owners. And $8 million for Gibbs.

On April 23, 2024, Gibbs pleaded guilty and will serve eighty-four months in prison, three years of probation, and ordered to pay over $8 million in restitution.

Great job by the Department of Health and Human Services’ Office of the Inspector General with this investigation.

Today’s Fraud of The Day is based on article “Clinic owner at center of multi-million dollar fraud scheme in Houston area sent to prison” published by Click2Houston on April 23, 2024.

A judge sentenced a Houston-area mental health clinic owner to prison after prosecutors say she was the ringleader of medical fraud for decades, resulting in millions of dollars. According to the U.S. Attorney’s Office for the Southern District of Texas, Gwendolyn Gibbs, 72, was the owner of Daybreak Rehabilitation Center. That’s where Gibbs reportedly submitted fake claims for hospitalization services to Medicare from 2007 until 2016.

Court records claim many of the patients, including those who were treated for severe mental illness or had intellectual disabilities, were impacted by this scheme. For example, Gibbs admitted “to falsifying medical records to make it appear that patients were sicker than they actually were.”

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