The Fifth Circuit of the U.S. Court of Appeals has upheld the convictions of former Merida Health Group owner Rodney Mesquais and CEO Henry McInnis for their involvement in a $152 million hospice fraud case.
In those convictions, Mesquais and McInnis received prison sentences of 25 and 15 years, respectively. The appeals court decision coincides with additional charges recently filed against both perpetrators.
“Overwhelming evidence established that Mesquias and McInnis committed health care fraud by abusing Medicare’s reimburse-first-verify-later system from 2009 to 2018,” the appeals court ruled. “That evidence is more than sufficient to support the guilty verdicts.”
Texas-based Merida Group ran a network of home health and hospice centers throughout its home state. Mesquais, McInnis and other conspirators engaged in a scheme to falsely certify patients who were not eligible to receive home health and hospice services.
Roughly 70% to 85% of patients were ineligible for the hospice care they received, according to prosecutors. These patients were often referred to hospice against the advice of their primary care physicians.
Mesquais, McInnis and their accomplices were also accused of threatening or terminating employees who refused to participate in these activities.
Combined charges against both included six counts of health care fraud, one count each of conspiracy to commit health care fraud and conspiracy to launder money. Mesquais faced an additional charge of conspiracy to pay kickbacks.
“To facilitate the fraudulent certification, Mesquias and McInnis built a roster of compliant in-house medical directors at Merida Group,” the court found. “The medical directors routinely lied about having seen patients face-to-face as Medicare requires, exaggerated how sick the patients were and made up diagnoses so that the patients would appear eligible for hospice, and fabricated medical records to cover their tracks.”
One patient testified at trial that Merida clinicians gave her a six-month terminal prognosis for an illness she did not have, leading her to contemplate suicide. She lost her appetite, isolated herself and stopped sleeping because she feared she would never wake up, court documents show.
“The scale of the scheme matched its cruelty. By the time they were caught, defendants had submitted over 47,000 claims for over 9000 patients,” appellate judges wrote in their decision. “They billed over $152 million to Medicare and received $124 million.”
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