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Houston Psychiatrist Convicted in $158 Million Medicare Fraud Scheme

By: James W. Kraus
September 16, 2015

On Thursday, a Houston psychiatrist was convicted of participating in a $158 million Medicare fraud scheme, following a seven day federal jury trial.  The charges against Sharon Iglehart, M.D., included conspiracy to commit health care fraud, one individual count of health care fraud and three counts of making false statements related to health care matters.

As reported by DOJ in a news release on Friday, the evidence presented at trial demonstrated that from 2006 until June 2012, Iglehart and others engaged in a scheme to defraud Medicare by submitting, through Riverside General Hospital (“Riverside”), approximately $158 million in false and fraudulent claims for Partial Hospitalization Program (“PHP”) services to Medicare.  A PHP is a form of intensive out-patient treatment for severe mental illness.

The evidence at trial demonstrated that the beneficiaries for whom Riverside billed Medicare did not receive PHP services, and rarely saw a psychiatrist.  Even when those beneficiaries did see a psychiatrist, they did not receive intensive psychiatric treatment.  The government also presented evidence that Iglehart personally billed Medicare for individual psychotherapy and other treatment to patients that she never actually provided.  This was exacerbated further by evidence that Iglehart falsified medical records of patients to make it appear as if she provided psychiatric treatment when, in fact, she did not.

Dr. Iglehart is the 13th individual to have been convicted of offenses based on their roles in the Riverside PHP scheme charged by the government.  This includes former Riverside President, Earnest Gibson, III, who was sentenced in June to 45 years in prison.  The details of his trial were outlined in a post on White-Collared on July 7, 2015.  Both Gibson and his son, Earnest Gibson, IV, have appealed their sentences.  Following his trial, Earnest Gibson, III, claimed that the government’s case was motivated by racism and a desire by others to obtain his hospital’s valuable real estate holdings in Houston’s Third Ward.  It is not known yet whether Dr. Iglehart will also file an appeal.