Prosecutions for defrauding the Medicare Part B Partial Hospitalization Program (PHP) are becoming increasingly common. PHP is a structured program under which community health centers and hospital outpatient departments deliver intense psychiatric care on an outpatient basis to enable patients with serious mental health problems to avoid hospitalization.
Regrettably, PHP has also become a magnet for fraud. One of the larger schemes involved a Texas hospital. In 2015, the hospital’s former president was ordered to pay restitution of $46,753,180 and spend 45 years in prison after being found guilty of 10 counts for his role in a $158 million PHP fraud scheme. Now age 76, the president made a bid to get the convictions set aside, but the Texas federal court said no dice and let the convictions stand. The laundry list of defenses that the court rejected included, among others:
- Defense counsel was ineffective because it didn’t research federal law on PHPs or object to certain evidence;
- The evidence supporting his convictions was insufficient;
- The prosecution’s evidence gathering was an illegal search and seizure under the Fourth Amendment;
- He was denied his Fifth Amendment due process rights;
- The prosecution’s failure to call a certain witness denied him his Sixth Amendment right to confront witnesses against him; and
- The government committed entrapment.
[United States v. Gibson, 2021 U.S. Dist. LEXIS 179712]