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Not Dead Yet

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Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

“I’m not dead yet!” The saying was immortalized in the 1975 comedy Monty Python and the Holy Grail in a scene where a character attempts to get rid of his still-living grandfather by adding him to the cart of dead bodies. In the scene, the grandson insists his grandfather is dead, or will be soon. The ‘almost dead’ man argues vehemently that he isn’t dead yet. On the contrary, he feels just fine. Merida Group must have outlined the details of their Medicare billing scheme using the script from The Holy Grail. Because their patients were not yet ready to be declared dead.

Merida Group is a large health care company with dozens of locations throughout Texas. They enrolled patients with long-term incurable diseases, such as Alzheimer’s and dementia, as well as patients with limited mental capacity who lived at group homes, nursing homes, and in housing projects. They also marketed hospice services, whether the patient was ready or not. They hired Jesus Virlar with specific instructions to make the patients appear “almost dead” a bonus plan contingent upon agreement to certify unqualified patients for hospice. Which he did. Virlar falsely told patients they had less than six months to live to fraudulently bill Medicare.  He also sent chaplains to the patients based on the false pretense they were near death. Virlar himself certified over $18 million in unnecessary hospice services as part of the over $150 million conspiracy.  In addition to regular medical director payments, Virlar received luxury trips, bottle service at exclusive nightclubs and other perks.

On September 28, 2023, Virlar was sentenced for medical fraud to 50 months in prison and ordered to pay $9 million in restitution.

Shout out to the Department of Health and Human Services.

Today’s Fraud of The Day is based on “Hospice Medical Director Receives 50-Month Prison Sentence for $150M Fraud” published by Hospice News on September 29, 2023

A federal judge has sentenced Jesus Virlar-Cadena, formerly a medical director for the Texas-based hospice company Merida Group, to 50 months in prison for his role in a $152 million scheme.

The court also ordered Virlar-Cadena to pay $9 million in restitution and $9 million in forfeiture. The Texas Medical Board suspended his medical license in 2019, when he pleaded guilty to the fraud charges. Several co-conspirators were also convicted, including the company’s owner, Rodney Mesquias, and CEO Henry McInnis.

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