Seven people, including hospital executives have been arrested by the FBI at Riverside General Hospital; among them, the hospital administrator/chief executive officer Ernest Gibson III.
The arrests are part of an ongoing federal probe into the hospital by the U.S. Department of Justice that began several months ago with the arrest of another executive with Riverside General Hospital.
Ernest Gibson IV, son of Ernest Gibson III, was also arrested Thursday morning.
Riverside General Hospital has a historical significance as the first to serve only the African American community in Houston.
The seven people arrested were charged for participating in a fraud scheme at Riverside General which led to $158 million in fraudulent billing for community mental health center services.
The administrators at Riverside General were paid kickbacks, in the form of cigarettes, food and coupons redeemable for items available at the hospital's "country stores," to Medicare beneficiaries in exchange for those beneficiaries' attendance at the hospital's partial hospitalization programs (PHP), according to court documents.
Beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare, according to a statement released Thursday by the U.S. Department of Justice.
Mohammad Kahn, the assistant administrator of the hospital, pleaded guilty on Feb. 22 to conspiracy to commit health care fraud and paying kickbacks related to $116 million worth of fraudulent claims submitted to Medicare. After his guilty plea, an additional $42 million in fraudulent claims were discovered, which altogether adds up to $158 million.
What is PHP?
An intermediate level of care for mental illness. Partial hospitalization programs (PHP)are full day programs within a psychiatric hospital or behavioral health department of a hospital. Patients participate generally weekdays for 7 to 8 hours at a time.
The programming consists of some groups, individual work (often daily), meetings with psychiatrists, as well as less structured socialization with the other patients. Groups and interventions are based on the needs of the patients within the program.
PHPs tend to have a wider range of the patients than lower levels of care. However, there are some PHPs that are set up for specific patient populations such as eating disorders, addictions, or borderline personality disorders.
Insurance generally covers PHP if it is determined to be medically necessary.
PHP can be a step down level of care for those who have been hospitalized, providing the therapeutic services of hospitalization while transitioning back to home.
PHP can also be used to provide patients with an intensive level of intervention and services, in an effort to prevent hospitalization.