Louisiana psychiatrist Zahid Imran, M.D. was sentenced to over seven years behind bars for participating in a Medicare fraud scheme involving partial hospitalization psychiatric services that were unnecessary or never provided, the U.S. Department of Justice announced. Imran's crimes were part of a long-running, $258 million fraud in which 17 people have been convicted.
Imran was tied to three community mental health centers (CMHCs) in Louisiana and Texas. He admitted mentally ill beneficiaries to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certified their appropriateness for the program to keep the Medicare reimbursement flowing. Imran and others falsified medical records to document performance of services not rendered, the Justice Department noted.
CMHCs provide mental health services to patients who live in a defined geographic area, according to a spotlight report by the Office of Inspector General. But hundreds of people traveled long distances to Louisiana by bus to receive therapy at Imran's facilities, according to The Advocate. Imran collected $1.9 million in the course of the scheme, prosecutors noted.
Hoor Naz Jafri, who was part owner of the three clinics, was sentenced last week to pay $43.5 million and serve more than eight years in prison for her role in the scheme, The Times-Picayune reported. She and her staff reportedly coerced beneficiaries at the residential apartments to use health center services whether they needed them or not, the article noted. Jafri also used a recruiter to pay patients to attend hospitalization programs.
CMHC fraud is neither new nor isolated, according to the OIG. In a study of CMHC billings, the agency found red flag utilization for about half of the providers reviewed.
"We've seen an explosion of fraud in community-based treatments," Assistant U.S. Attorney Ted Radway told FierceHealthPayer: Anti-Fraud in an exclusive interview. "[W]e see billing for services not rendered, services provided by unqualified individuals or services tainted by kickbacks."
Targeted CMHC enforcement activities began in Baton Rouge in 2008, the OIG report stated.