Nurse Faces Prison for Partial Hospitalization Medicare Fraud

A registered nurse and an intake specialist at a community mental health center have  pleaded guilty to conspiracy to commit health care fraud.  They each face up to five years in prison when they are sentenced.

Both employees worked at Health Care Solutions Network, which operated community mental health centers in Florida and North Carolina.  The company provided partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.

According to the government, the two employees helped their employer bill Medicare and Medicaid for mental health treatment that was unnecessary and, in many instances, not even provided.

John Thoen, a registered nurse, was charged with admitting patients who were not eligible for PHP services.  He was accused of creating false medical records that were used to support false billing to Medicare and Medicaid.

Alexandra Haynes, an intake specialist, was also charged with creating false patient medical records including false group therapy notes.

Their employer, Health Care Solutions Network, was accused of a broader Medicare fraud scheme that included paying kickbacks to owners and operators of assisted living facilities who referred Medicare and Medicaid patients for treatment.  Paying kickbacks in return for patient referrals is illegal under the Anti-Kickback Statute.  Any claim for treatment resulting from kickbacks also constitutes a false claim under the False Claims Act.

This is a wakeup call for any doctor, nurse, medical biller, or other healthcare professional who believes their employer may be submitting false claims to Medicare or Medicaid.  If you helped to create the patient medical records that are being used in the submission of false claims, you are at serious risk of civil penalties, criminal charges, and even loss of your professional license.

Fortunately, you do have options – especially if you take action before the FBI comes knocking on your door.  You may be able to avoid prosecution.  You may even be entitled to a substantial reward for helping the government stop Medicare fraud.

If you are aware that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights.  To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me via email.

John Howley, Esq.

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