$97 Million In Medicare Fraud Again This Time In Houston TX

The two physician owners of a Houston-area mental health clinic were sentenced to 148 months and 120 months respectively for their roles in a $97 million Medicare fraud scheme. A group home owner who sent residents to the clinic in exchange for kickbacks was also sentenced to 54 months in prison for her role.

Physicians Mansour Sanjar, 81, and Cyrus Sajadi, 67, the owners of Spectrum Care P.A., a community mental health clinic, were each convicted following a jury trial on March 12, 2014, of conspiracy to commit health care fraud and conspiracy to pay and receive kickbacks, as well as related counts of health care fraud and paying illegal kickbacks.  Chandra Nunn, 36, a group home owner, was convicted of conspiracy to commit health care fraud and conspiracy to pay and receive kickbacks, as well as related counts of receiving illegal kickbacks.  In addition to the prison sentences, U.S. District Judge Vanessa D. Gilmore of the Southern District of Texas ordered Sanjar and Sajadi to pay $8,058,612.39 in restitution, and Nunn to pay $1,885,667.41 in restitution.  Co-defendants Adam Main, Shokoufeh Hakimi, Sharonda Holmes and Shawn Manney were also convicted and are scheduled to be sentenced on Jan. 20, 2015.

According to evidence presented at trial, Sanjar and Sajadi invented scheme to defraud Medicare beginning in 2006 and continuing until their arrest in December 2011.  Sanjar and Sajadi owned Spectrum, which purportedly provided partial hospitalization program (PHP) services.  A PHP is a form of intensive outpatient treatment for severe mental illness.  The Medicare beneficiaries for whom Spectrum billed Medicare for PHP services did not qualify for or need PHP services.

Evidence showed that Sanjar and Sajadi signed admission documents and progress notes certifying that patients qualified for PHP services, when in fact, the patients did not qualify for or need PHP services.  Sanjar and Sajadi also billed Medicare for PHP services when the beneficiaries were actually watching movies, coloring and playing games, which are not activities covered by Medicare.

Other evidence also showed that Sanjar and Sajadi paid kickbacks to group care home operators and patient recruiters, including Nunn, Holmes and Manney, in exchange for delivering ineligible Medicare beneficiaries to Spectrum.  In some cases, the patients received a portion of those kickbacks.