Former Palo Pinto General Hospital CEO Harris Brooks pleaded guilty to defrauding BlueCross BlueShield of Texas, CIGNA Texas, and United Healthcare for millions of dollars, according to U.S. Attorney for the Northern District of Texas Erin Nealy Cox.
An FBI investigation revealed that Brooks and his co-conspirators used the hospital’s in-network contracts with the insurance companies to defraud them for laboratory services from September 2017 to June 2018. They used a process called pass-through billing, where a physician orders a service but that physician does not actually complete the service for which he or she billed.
They submitted claims for allergy and genetic testing that the hospital did not have equipment to perform onsite. The claims were for unsuspecting patients receiving treatment at spas and clinics throughout Texas, but not at the hospital in Mineral Wells, west of Fort Worth. For nine-months, Brooks and his partners submitted $55 million worth of claims, most of which were for services not performed at the hospital. Insurance companies paid the hospital more than $9 million.
Harris said he hoped to receive higher reimbursement rates from the insurance companies. He faces up to five years in prison and will be required to pay restitution to those he defrauded.
Source: North Texas Hospital CEO Pleads Guilty to Millions in Fraud / Healthcare D Magazine