CEO Sentenced for $150 Million Well being Care Fraud and Cash Laundering Scheme | OPA

The CEO of a Texas-based group of hospice and home health care facilities was sentenced today to 15 years in prison for incorrectly telling thousands of patients with long-term terminal diseases that they had less than six months to live to admit the patients to the hospice Programs they were otherwise not qualified for, thereby increasing revenue for the company.

Henry McInnis, 50, of Harlingen, Texas, was convicted of a federal jury in Brownsville, Texas in November 2019 of one conspiracy each: conspiracy to commit healthcare fraud, conspiracy to commit money laundering, obstruction of justice, and six counts of healthcare fraud.

McInnis co-conspirator, Rodney Mesquias, 50, who owns the hospice and home health facilities, was also convicted after the November 2019 trial. He was sentenced Two other co-conspirators have pleaded guilty and are awaiting conviction.

“As CEO of the company, McInnis has directly overseen a reprehensible criminal system that included filing fraudulent bills of over $ 150 million, forging patient records and paying unlawful setbacks,” said Acting Attorney General Nicholas L. McQuaid of the Department of Justice’s Criminal Division. “McInnis has hunted down some of the most vulnerable members of our society, including many who have suffered from mental impairment and who have been falsely and cruelly told by co-conspirators that they only have months to live. Today’s Significant Sentence shows that the department continues to seek to prosecute individuals at all levels of corporate governance who engage in criminal activities where profits take precedence over patient care. ”

“Families try to give comfort and support to their sick loved ones when all other medical options are gone,” said Christopher Combs, special agent in charge of the FBI’s San Antonio office. “It is incomprehensible and evil to chase after 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 the reprehensible and fraudulent acts of his co-conspirator to defraud Medicare were not without harm: Vulnerable beneficiaries were unnecessarily admitted to hospice care, leaving them unable to access the necessary medical care,” said Miranda L. Bennett, the US special agent Ministry of Health and Human Services Inspector General’s Office (HHS-OIG) in the Dallas area. “With our law enforcement partners, we will continue to investigate those who put illicit profits above the well-being of patients in our healthcare system.”

From 2009 to 2018, McInnis, Mesquias, and others launched a program that resulted in over $ 150 million in false and fraudulent claims for hospice and other health services. McInnis served as the chief executive officer and administrator, overseeing the day-to-day operations of the Merida Group, a large healthcare company with dozens of locations across Texas.

McInnis had no medical training and previously worked as an electrician. However, he was the de facto Nursing Director of the Merida Group. Witnesses in court testified that McInnis directed staff to admit unskilled patients to the hospice and home health setting, keep unskilled patients on service for extended periods of time, and fire and reprimand staff who refused to participate in the program .

McInnis also oversaw and enforced a company-wide practice of forging medical records to hide the system. Several witnesses testified that McInnis ordered staff to modify medical records to create the impression that the patients were terminally ill. In reality, some were employed or even participated in sporting events. The jury also heard that McInnis stated that the purpose of the forged records was to enable the Merida Group to audit insurance companies.

As CEO, McInnis also passed a policy that paid for illegal setbacks. They sent bribes to doctors under the guise of medical director fees to certify unskilled patients for hospice and home health. In some cases, they were wrongly offering payouts to marketers in exchange for recruiting patients who could be transferred to extremely expensive hospice services.

HHS-OIG, FBI, and Texas Health and Human Services Commission conducted the investigation. Deputy Chief Jacob Foster and Trial Attorney Kevin Lowell of the Criminal Division’s Fraud Department and U.S. Assistant Attorney Andrew Swartz of the Southern District of Texas are pursuing the case.

The fraud department heads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces in 24 districts, has indicted more than 4,200 defendants who billed the Medicare program nearly $ 19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, in partnership with the HHS-OIG, are taking steps to increase accountability and reduce the presence of fraudulent providers.