The Grim Reaper Cometh

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New Medicare Card ++First one rejected for Copyright Trademark issues. Please let me know what I need to remove or alter. Is it the DHHS LOGO? Card design curve? Part of number shown? You accept Social Security cards with the same logo. This was accepted in 2018. iStock # 653549364. Just let me know how to get the new card accepted… thanks!++++

The Grim Reaper is death personified. (Kind of a harsh way to start a fraud blog but stick with me.) A Texas corporate executive and his co-conspirator essentially assumed the role of this hideous creature. They falsely told thousands of patients with long-term illnesses they were going to die soon, and then enrolled them in hospice programs. Fortunately, the Department of Justice came after them with a healthcare fraud conviction and not a scythe.

These two fraudsters scammed thousands of patients who had Alzheimer’s and dementia. Just so you know, once Medicare beneficiaries enter hospice care, the government healthcare program ceases to provide curative medical treatment. (This is a huge problem for the folks in hospice care who were not dying.)

Rodney Mesquias, who owned Merida Health Care Group (MHCG), had dozens of locations across the state of Texas. His CEO, Henry McInnis, helped him carry out the devious scheme over nine years.

Many of their victims were still very active when told they would soon die. They could walk, drive, even coach sports, but they were told they would die within six months. To carry out the ruse, the company provided chaplains to discuss last rites and prepare the patients for their imminent death. In the meantime, MHCG signed these folks up for group homes, nursing homes, and housing projects.

According to AARP, “Some patients were put on feeding tubes to keep them alive, for example, even though the procedure didn’t benefit them medically but rather served only to extend their suffering and generate more money for the Merida Group.” Many of the patients were unnecessarily kept on hospice for years while the Medicare funds continued to pour into the company’s coffers.

Dr. Francisco Peña, a physician who served as MHCG’s medical director, told a witness that the way to make money was to keep patients alive for as long as possible. (It’s interesting to note that Peña was also the mayor of Rio Bravo, Tex., at the time. Busy guy.)

Mesquias and McInnis, both 48, were convicted of one count each of conspiracy to commit healthcare fraud, conspiracy to commit money laundering and conspiracy to obstruct justice and six counts of healthcare fraud. Mesquias was also convicted on one count of conspiracy to pay and receive kickbacks and sentenced to 20 years in prison. (The scheme also involved kickbacks to doctors for referring patients for hospice care even though they didn’t need it.) Mesquias is also required to pay $120 million in restitution.

Unfortunately, The Grim Reaper did make an appearance. (He came for Dr. Francisco Peña in November 2020 when he succumbed to COVID-19 at age 84 while in detention.)

It is no surprise that Mesquias, McInnis, and Peña indulged excessively using government proceeds. They purchased luxury vehicles, real estate, jewelry, clothing, season tickets for the San Antonio Spurs, and bottle service at Las Vegas nightclubs. (I highly doubt any of that will be available where these guys are going.)

If you suspect Medicare or Medicaid fraud, please report it by calling 1-800-447-8477 or via email at HHSTips@oig.hhs.gov.

Today’s Fraud of the Day comes from an article, “Texas Man Sentenced To 20 Years For Hospice Fraud Scheme,” published by NPR on December 17, 2020.

A Texas corporate executive has been sentenced by a federal jury to 20 years in prison for running a scheme in which people with long-term illnesses were falsely told they would die soon, and then enrolled them in hospice programs.

In the scheme, thousands of patients with diseases like Alzheimer’s and other types of dementia were told they had just six months to live, the Justice Department said in a press release Thursday. Entering hospice care meant that Medicare would not cover curative medical treatment.

 

 

 

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.