BIRMINGHAM—A federal judge today sentenced a Muscle Shoals man to 28 months in prison for taking part in a health care fraud totaling more than $3 million in connection to a hospice care program he operated, announced U.S. Attorney Joyce White Vance, FBI Special Agent in Charge Patrick Maley and Health and Human Services, Office of Inspector General, Special Agent in Charge Derrick Jackson.
U.S. District Judge Inge P. Johnson sentenced JACKIE RANDOPLH GIST, 55, for engaging in a criminal conspiracy to defraud Medicare from about March 2006 to July 2009. During that time, Gist operated Good Samaritan Hospice USA Inc., an Alabama corporation that provided hospice care in Muscle Shoals. Gist pleaded guilty in September to one count of conspiracy to commit health care fraud and three counts of health care fraud and agreed to forfeit $3,192,285 to the government as proceeds of illegal activity. Gist must report to prison April 2.
“In three years this defendant stole more than $3 million from the Medicare program, costing all U.S. taxpayers,” Vance said. “This office will not tolerate such fraud and remains committed to aggressively prosecuting individuals and companies that seek to steal from government programs.”
Medicare’s hospice benefit program allows a beneficiary with a terminal illness to forgo curative treatment for the illness and instead receive palliative care, which is the relief of pain and other uncomfortable symptoms.
Gist’s scheme involved submitting claims to Medicare for amounts greater than warranted for the services provided, according to the charges and his plea agreement. The billing code which Gist caused GSH to submit to Medicare is generally used for services provided in an inpatient facility for pain control or acute or chronic symptom management that cannot be managed in other settings and is typically provided in the short-term. However, the services GSH provided were routine services, not inpatient services.
As a result of the scheme, GSH received reimbursements from Medicare totaling $4,108,924 when, if the correct code had been used, GSH would have been reimbursed $916,639. Accordingly, the fraud resulted in a loss to the Medicare program of about $3,192,285.
This prosecution is part of President Barack Obama’s Financial Fraud Enforcement Task Force. President Obama established the interagency task force to wage an aggressive, coordinated, and proactive effort to investigate and prosecute financial crimes. The task force includes representatives from a broad range of federal agencies, regulatory authorities, inspectors general, and state and local law enforcement who, working together, bring to bear a powerful array of criminal and civil enforcement resources. The task force is working to improve efforts across the federal executive branch, and with state and local partners, to investigate and prosecute significant financial crimes, ensure just and effective punishment for those who perpetrate financial crimes, combat discrimination in the lending and financial markets, and recover proceeds for victims of financial crimes.
The FBI and the Department of Health and Human Services, Office of the Inspector General, investigated the case. Assistant U.S. Attorney Lloyd Peeples prosecuted the case.