Horrific Medicare Scam At Louisiana And Texas Mental Health Facilities

Tristyn Bloom Contributor
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The owner of two mental health clinics in Louisiana has been sentenced to nearly eight years in prison for stealing millions of taxpayer dollars in an elaborate Medicare fraud scheme involving beneficiary recruiters, managers, therapists and a psychiatrist that lasted over seven years.

Fifty-three-year-old Roslyn Dogan co-owned the Serenity Center of Baton Rouge, where she facilitated the “treatment” of Medicare beneficiaries formerly living in nursing homes with no need for psychotherapy.

She worked with recruiters to bring them into her care and kept them there as long as she could to milk Medicare funds, even having them involuntarily committed to psychiatric hospitals only to be released again into one of the facilities she controlled (she was also manager and marketer for Baton Rouge’s Shifa Community Mental Health Center).

To hide her scheme from the authorities, she ordered her employees to falsify treatment records and intercepted billing statements to prevent her “patients” from seeing the treatments they were being billed for. (RELATED: More Doctors Indicted For Prescribing Unnecessary Medical Treatment In $56 Million Medicare Fraud)

The scheme extended beyond Louisiana all the way to Texas, where a co-conspirator recruited Medicare beneficiaries to the Shifa Community Mental Health Center in Houston, which, together with the Baton Rouge facilities, was owned by Hoor Naz Jafri,a recently naturalized Indian citizen. Jafri was sentenced to to nearly nine years in prison for her role in the conspiracy earlier this summer.

The recruiter, James Hunter, was paid $1,500 weekly in exchange for his services. According to the DOJ’s announcement, “Hunter recruited Medicare recipients from group homes who were not appropriate for the [psychiatric] services, but who agreed to attend the program in exchange for $75 cash per week. To ensure their admittance to the program, Hunter instructed each beneficiary as what to say to physicians regarding their supposed psychiatric symptoms. As a result of the kickback scheme with Hunter, the Houston facility billed Medicare approximately $16.5 million.”

Jafri and Dogan worked together to “maximize” the number of Medicare beneficiaries at their facilities and to keep them there as long as possible, shuffling patients from doctor to doctor if one found a patient ineligible for treatment, ignoring doctor and therapist complaints that the treatment available was not appropriate. (RELATED: Medicare Wasted Millions On HIV Treatments For Patients Who Didn’t Have HIV)

According to a 2012 court document obtained by The Daily Caller, “on multiple occasions, Jafri and Dogan specifically instructed therapists to create group therapy notes and other documentation for patients on days on which the patients did not receive any therapy — either because these patients did not attend the program or because the program did not provide any therapy. In addition, they pressured administrators to maximize billing, and they encouraged and condoned the regular falsification of patient documentation.”

Jafri was also manager and director of several apartment complexes where some of the Medicare beneficiaries lived, who were told that in order to live there they had to obtain treatment at one of her facilities, regardless of whether they wanted or needed such treatment. According to the court document, these beneficiaries “were particularly vulnerable because many came from Tennessee or other remote locations and had no family or friends to advocate on their behalf. All or most of these patients suffered from drug addiction and/or chronic mental illnesses, so they could not advocate for themselves.”

“These convictions resulted from a massive fraud involving thousands of false billings for mental health services that were either not needed or not given,” said Acting Assistant Attorney General David O’Neil last spring, when Dogan and Hunter were found guilty.  “It was a sophisticated scheme involving kickbacks, falsified medical records and false billings.  We will use all tools at our disposal — from data to traditional law enforcement techniques — to root out these schemes and bring the appropriate people to justice.”

All told the conspiracy billed Medicare for $258.5 million, of which Medicare paid out $43.5 million. Dogan was convicted in May 2014, and has been ordered to pay all $43.5 million in restitution — and sentenced to 90 months (7.5 years) in prison.

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