Final Defendants Sentenced in Massive Texas Work Comp/Healthcare Fraud Case

The remaining defendants in a North Texas medical center healthcare and workers’ compensation fraud scheme have been sentenced, the Texas Division of Workers’ Compensation reported

It’s the final chapter in what was a multi-million dollar fraud and bribery case that began in 2016 and involved Forest Park Medical Center in Dallas and 14 defendants, the DWC said. The defendants involved in the case were sentenced to a combined 74+ years in federal prison and ordered to pay $82.9 million in restitution.

The DWC said that surgeons, physicians, and hospital administrators had steered patients, including many in the state workers’ compensation system, to Forest Park Medical Hospital. Surgeons got kickbacks, disguised as marketing or consulting fees for these referrals.

“Instead of basing decisions on patient needs, these health care providers sought to maximize their own income. Activities like this reflect a complete lack of patient care,” DWC’s Deputy Commissioner of Compliance and Investigations, Debra Knight, said in a media release.

Eleven of the defendants participated in the Texas workers’ compensation system, including a nurse who recruited and preauthorized workers’ compensation requests, and the founder of a company that filled out preauthorization for workers’ compensation patients.

The DWC Fraud Unit identified Forest Park health care providers who billed within the state’s workers’ compensation system and provided data and investigation documents to the FBI for seven of the defendants. The Fraud Unit found that insurance carriers in the Texas workers’ compensation system alone were billed a little over $14 million and paid $2.6 million in this case.

The U.S. Attorney’s Office for the Northern District of Texas said those sentenced in the case include:

• Hospital manager Alan Andrew Beauchamp – who pleaded guilty in August 2018 to one count of conspiracy to pay healthcare bribes and one count of commercial bribery under the Travel Act, then testified for the government during his coconspirators’ trial – was sentenced to 63 months in federal prison.
• Wilton “Mac” Burt, Forest Park’s managing partner, was sentenced to 150 months in federal prison.
• Jackson Jacob, owner of the shell companies through which some of the bribes were routed, was sentenced to 96 months in federal prison.
• Dr. Douglas Won, a spinal surgeon, was sentenced to 60 months in federal prison.
• Dr. Michael Rimlawi, a spinal surgeon who partnered with Won, was found guilty on three of four counts, including conspiracy and two counts of receiving kickbacks. He was sentenced Thursday to 90 months in federal prison.
• Dr. Shawn Henry, a spinal surgeon who invested in FMPC, was sentenced to 90 months in federal prison.
• Dr. Mrugeshkumar Shah, a pain management doctor, was sentenced to 42 months in federal prison.
• Iris Forrest, a nurse who recruited and preauthorized worker’s comp requests, was sentenced to 36 months in federal prison.
• Israel Ortiz, the founder of Kortmed, a company that fills out preauthorization for worker’s comp patients, was sentenced to 12 months in federal prison.
• Dr. Wade Neal Barker, a bariatric surgeon who co-founded Forest Park in 2008, was sentenced to 60 months in federal prison.
• Andrew Jonathan Hillman, a co-owner of Hospital Business Concepts, a surgeon brokerage, was sentenced to 60 months in federal prison.
• Dr. Frank Gonzalez, a chiropractor who referred patients to Forest Park in return for bribes, was sentenced to 21 months in federal prison.
• Semyon Narosov, a co-owner of Hospital Business Concepts, was sentenced to 51 months in federal prison.
• Dr. Richard Toussaint Jr., an anesthesiologist who co-founded Forest Park in 2008, was sentenced to 60 months in federal prison.
• Carli Adel Hempel, who pleaded guilty in July 2019 to conspiracy to misapply property of a health care benefit program, was sentenced to three years’ probation.
• Kelly Wade Loter and Andrea Kay Smith, who both pleaded guilty to misprision of a felony (failure to report a felony), were sentenced to three and five years’ probation, respectively.

In addition to the $82.9 million restitution, the government plans to collect more than $25.5 million in money judgments against those convicted in the Forest Park scheme.

The case was investigated by the Federal Bureau of Investigation, the U.S. Department of Labor Office of Inspector General, the U.S. Department of Labor Employee Benefits Security Administration, the U.S. Department of Defense – Defense Criminal Investigative Service, the U.S. Office of Personnel Management Office of Inspector General, and Internal Revenue Service Criminal Investigation, with assistance from the Food and Drug Administration and the U.S. Postal Inspection Service. Assistant U.S. Attorneys Andrew Wirmani, Kate Pfeifle (fmr), Marcus Busch, Mark Tindall (fmr), and Gail Hayworth prosecuted the case.

Source: Texas DWC; U.S. Attorney’s Office

Topics Texas Fraud Workers' Compensation