U.S. District Court Judge Rolanda Olvera ordered Rodney Mesquias, owner of the hospice and home health company Merida Group, to serve a 20-year federal prison sentence as well as pay $120 million in restitution. San Antonio-based Merida Group operates dozens of locations throughout Texas.
While false claims cases are relatively common in the hospice space. This is one of the first to result in clinical charges. A jury found Mesquias, CEO Henry McInnis, and medical director Francisco Pena guilty of one count each of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.
“Financial healthcare fraud is abhorrent enough, but to fraudulently diagnose patients with dementia or Alzheimer’s is the pinnacle of medical cruelty to both the patient and their family,” said U.S. Attorney Ryan K. Patrick of the Southern District of Texas. “They falsely gave patients life ending diagnosis, and they will pay the price with years behind bars.”
Mesquias and McInnis were found guilty of six counts of health care fraud and one count of conspiracy to obstruct justice. Pena was also convicted of one count of health care fraud, obstruction of health care investigations and one count of making false statements to the FBI. The court also convicted Mesquias and Pena of engaging in a conspiracy to pay and receive kickbacks, according to the U.S. Department of Justice.
The company’s fraudulent claims totaled $154 million, according to the Justice Department.
The crimes were investigated by the Medicare Fraud Strike Force, a collaboration of state and federal and local officials coordinated by the U.S. Department of Health & Human Services Office of the Inspector General.
According to prosecutors, the Merida Group certified patients for hospice who were not eligible and placed many of them in group homes, nursing homes and public housing. While the patients were suffering from serious illnesses, such as dementia, that are likely to eventually claim their lives, they did not have a legitimate six-month terminal prognosis.
The three conspirators used the illegally obtained revenue to finance lavish lifestyles, with purchases including designer clothing, real estate, season tickets for sporting events, parties and luxury vehicles, the Justice Department indicated.
The obstruction of justice charges for Mesquias and McInnis followed discovery of falsified medical records including phony diagnostic test results. The Merida executives had presented this false information to a federal grand jury, according to prosecutors.
“Mesquias’ scheme included paying kickbacks to physicians and fraudulently enrolling vulnerable beneficiaries in hospice care that prevented them from accessing curative care,” said Special Agent in Charge Miranda L. Bennett of the U.S. Department of Health and Human Services Office of Inspector General’s Dallas Region. “This victimization is intolerable, and our investigators and law enforcement partners will continue to work hard to bring such criminals to justice and to protect those relying on federal health care programs.”