CEO who lied to thousands of patients by telling them they had less than six months to live in order to enroll them in hospice sentenced to prison
There are bad breaches, and then there are the ones where words like “despicable,” “evil,” “immoral,” “disgusting,” and “reprehensible” just seem too weak to express how decent people might feel. This case out of Texas is one of those. Here is DOJ’s press release issued today:
The CEO of a Texas-based group of hospice and home health entities was sentenced today to 15 years in prison for falsely telling thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified, thereby increasing revenue to the company.
Henry McInnis, 50, of Harlingen, Texas was convicted by a federal jury in Brownsville, Texas, in November 2019 of one count each of conspiracy to commit health care fraud, conspiracy to commit money laundering, obstruction of justice, as well as six counts of health care fraud.
McInnis’s co-conspirator, Rodney Mesquias, 50, the owner of the hospice and home health entities, was also convicted following the November 2019 trial. He was sentenced to 240 months in prison in December 2020. Two other co-conspirators have pleaded guilty and are awaiting sentencing.
“McInnis, as CEO of the company, directly oversaw a reprehensible criminal scheme that involved the submission of over $150 million in fraudulent bills, the falsification of patients’ medical records, and the payment of unlawful kickbacks,” said Acting Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division. “McInnis preyed upon some of the most vulnerable members of our society, including many who suffered from diminished mental capacity and who were falsely and cruelly told by co-conspirators that they had only months to live. Today’s significant sentence demonstrates the department’s continued commitment to pursuing individuals, at all levels of corporate management, who engage in criminal schemes that prioritize profits over patient care.”
“Families seek to give comfort and support to their ailing loved ones when all other medical options are gone,” said Special Agent in Charge Christopher Combs of the FBI’s San Antonio Field Office. “It is unconscionable and evil to prey upon the most vulnerable in our community to commit fraud against government-funded programs. The FBI is committed to protecting our communities from those who may not have the strength to protect themselves.”
“McInnis and his co-conspirator’s reprehensible and deceitful actions to defraud Medicare weren’t without harm: vulnerable beneficiaries were unnecessarily enrolled in hospice care, preventing them from accessing needed curative care,” said Special Agent in Charge Miranda L. Bennett, U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region. “With our law enforcement partners, we will continue to investigate those who put ill-gotten profits above the well-being of patients in our health care system.”
From 2009 to 2018, McInnis, Mesquias and others orchestrated a scheme that involved the submission of over $150 million in false and fraudulent claims for hospice and other health care services. McInnis served as the top corporate officer and administrator and oversaw the day-to-day operations of the Merida Group, a large health care company that operated dozens of locations throughout Texas.
McInnis had no medical training and worked previously as an electrician. However, he acted as the de facto director of nursing for the Merida Group. Witnesses at trial testified McInnis directed employees to admit unqualified patients to hospice and home health, keep unqualified patients on services for long periods of time and fired and reprimanded employees who refused to participate in the scheme.
McInnis also oversaw and enforced a company-wide practice of falsifying medical records to conceal the scheme. Multiple witnesses testified McInnis ordered employees to alter medical records to make it appear patients were terminally ill. In reality, some were employed or even participating in sporting events. The jury also heard that McInnis explained the purpose of the falsified records was to allow the Merida Group to pass insurance company audits.
As CEO, McInnis also adopted a policy that paid illegal kickbacks. They directed bribes to physicians under the guise of medical director fees to certify unqualified patients for hospice and home health. In some cases, they improperly offered payoffs to marketers in exchange for recruitment of patients who could be placed on extremely expensive hospice services.
HHS-OIG, FBI and Texas Health and Human Services Commission conducted the investigation. Assistant Chief Jacob Foster and Trial Attorney Kevin Lowell of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Andrew Swartz of the Southern District of Texas are prosecuting the case.
The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.