A new Medicare fraud lawsuit has concluded with a former clinic operator being assessed prison time. The defendant was accused of committing Medicare fraud to the tune of $158 million.

The Texas federal judge overseeing the Medicare fraud lawsuit has sentenced defendant William Bullock III, who operated the mental health clinic in question, to a total of three and a half years in prison. Prosecutors allege that the Medicare fraud involved several million dollars being paid by the federal government for fraudulent claims.

Due to Bullock’s alleged cooperation in the pursuit of the Medicare fraud lawsuit and resolution, the individual does not have to report to the Bureau of Prisons until after the holidays.

The defendant involved in the Medicare fraud claim had been indicted in 2012 and did not log any release condition violations during that time. He entered into a plea agreement with the federal government over the Medicare fraud lawsuit in August 2014, at which time the defendant admitted his guilt.

The government agreed to work with the defendant as a result of the defendant’s cooperation, so he was only prosecuted for one count of conspiracy to commit health care fraud. These Medicare fraud allegations carry a maximum penalty of 10 years in prison.

The Medicare fraud case began when the defendant who was responsible for satellite location operation of the Riverside General Hospital in Houston allegedly received hospital kickbacks in exchange for using beneficiaries receiving Medicare to get partial hospitalization program services for psychiatry.

According to the Medicare fraud allegations, between 2010 and 2012, Riverside Hospital submitted claims to Medicare totaling above $6 million for these PHP or Psychiatric Partial Hospitalization Program services. However, Medicare only paid the hospital $2 million of those claims and as part of the conclusion of the Medicare fraud case, the defendant also had to pay $2 million in restitution.

More than 15 different people were convicted in this Medicare fraud scheme including the former president of the hospital who received a 20-year prison sentence. Other individuals accused in this Medicare fraud scheme allegedly carried out different services and submitted fraudulent claims to the federal health care program.

Various types of Medicare and Medicaid fraud happen every year, and the federal government often becomes aware of these claims through the assistance of a whistleblower.

The most common type of Medicare fraud involves submitting false claims for payment from the U.S. government healthcare program. Since this program is supported by taxpayers, the government takes allegations of healthcare fraud quite seriously, pursuing criminal charges against those who have been involved in the submission of fraudulent claims or running more complex schemes.

Many individuals involved in Medicare fraud schemes have been caught and charged as a direct result of an inside whistleblower’s knowledge about the situation. The federal government does not always intervene, but maintains the discretion to do so.

The Medicare Fraud Lawsuit is U.S. v. Gibson, et al., Case No. 4:12-CRD00600 in the U.S. District Court for the Southern District of Texas.