CEO Henry McInnis of Merida Health Group in Texas has been sentenced to 15 years in prison for his role in a $154 million Medicare fraud scheme involving false claims for hospice care. A jury in 2020 found McInnis, company owner Rodney Mesquias, and medical director Francisco Pena guilty of conspiracy to commit health care fraud and conspiracy to commit money laundering.
In some instances, investigators found that company representatives lied to patients and families, saying that death was imminent when it in fact was not, among other allegations. The government tried them under the False Claims Act.
“McInnis, as CEO of the company, directly oversaw a reprehensible criminal scheme that involved the submission of over $150 million in fraudulent bills, the falsification of patients’ medical records, and the payment of unlawful kickbacks,” said Acting Assistant Attorney General Nicholas L. McQuaid, of the Justice Department’s Criminal Division. “The defendant preyed upon some of the most vulnerable members of our society, including many who suffered from diminished mental capacity.”
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.
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 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 the Justice Department.
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, according to prosecutors.
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. Founded in 2007, the strike force has 15 units in 24 districts and has charged more than 4,200 individuals for a total $19 billion in Medicare fraud.
“Families seek to give comfort and support to their ailing loved ones when all other medical options are gone,” said Special Agent in Charge Christopher Combs of the FBI’s San Antonio Field Office. “It is unconscionable and evil to prey upon the most vulnerable in our community to commit fraud against government-funded programs.”