San Angelo Doctor Charged with 52 Counts of Health Care Fraud

 

LUBBOCK— A licensed psychiatrist, who submitted claims for services rendered to nursing home residents in San Angelo, and other communities in the counties surrounding Tom Green County, Texas, is in federal custody on charges that he defrauded Medicare and Medicaid of nearly $1.75 million, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.

Robert Hadley Gross, who is licensed by the Texas Medical Board with a primary practice in psychiatry, is charged in an indictment returned yesterday by a federal grand jury in Lubbock, with 52 counts of health care fraud. Gross was arrested yesterday evening at his office in San Angelo and is scheduled to make his initial appearance before a U.S. Magistrate Judge today in Abilene.

The indictment alleges that beginning in approximately January 2009 and continuing to approximately June 20, 2014, Gross ran a scheme to defraud Medicare and Medicaid, and other health insurance carriers, by filing claims for payment for services that were never rendered and for services that were billed using inappropriate CPT codes. When submitting a claim, the provider identifies the type of service performed in each submitted claim by means of a code for the type of service listed in the American Medical Association’s publication called the Current Procedural Terminology (CPT) Manual. This five-digit code dictates the amount of payment the provider receives for the rendered service.

In addition to regularly submitting claims for services rendered to nursing home residents, Gross also regularly submitted claims for services provided to clients of mental health and mental retardation (MHMR) organizations in San Angelo, Midland, and Abilene, in addition to claims for services rendered to patients in his office in San Angelo. In addition, during 2009 and 2010, Gross submitted claims for services provided to foster care children in Brownwood, Texas.

As part of his scheme, according to the indictment, Gross, for numerous dates of service, filed claims for services rendered which, for each of those dates, would entail Gross spending more time than his typical workday. In many instances involving his nursing home, MHMR and office patients, Gross upcoded claims for services for patients with whom he actually had contact. Upcoding is a fraudulent practice in which a provider claims a higher level CPT procedure code than was actually performed, resulting in a higher payment to the provider.

Gross, in numerous instances involving his nursing home patients, filed claims for services on dates he did not actually see the patients. In those instances, the patient may have been present at the nursing home at the time of his visit, or the patient may have died or been discharged before Gross’ visit.

Counts one through five of the indictment allege that Gross submitted claims to Medicaid and Medicare for services allegedly rendered on days in April and May 2014, to patients at MHMR and nursing home facilities, which Gross could not have rendered during the limited amount of time he was at the facilities. 

Count six alleges that on March 20, 2013, Gross submitted a claim to Medicaid and Medicare for services allegedly rendered to a patient at a nursing home in San Angelo on the patient’s actual date of death, when, in fact, the patient had been discharged from the nursing home the previous day and admitted to the hospital where the patient died.

Counts seven through 52 allege that on various dates ranging from March 26, 2009, to July 20, 2012, Gross submitted claims to Medicare and Medicaid for services allegedly rendered after patients had died.

An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. If convicted, however, each of the 52 counts of health care fraud carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine. Restitution could also be ordered. In addition, the indictment includes a forfeiture allegation that would require Gross, upon conviction, to forfeit: 1) at least $1.75 million in a money judgment for the proceeds traceable to the commission of each offense; 2) approximately $3 million in cash seized from various bank accounts in San Angelo and in Ft. Washington, Pennsylvania, as well as from T. Rowe Price accounts; and 3) three parcels of real estate in San Angelo and Rockport.

The Federal Bureau of Investigation, Health and Human Services Office of Inspector General, and Medicaid Fraud Control Unit, Office of the Texas Attorney General are investigating. Assistant U.S. Attorney Ann Cruce-Haag is handling the prosecution, and Assistant U.S. Attorney John de la Garza is handling the forfeiture.

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Dumba$$....... Hopefully they will seize everything he's ever had.... home, office, cars, furniture, wife's clothing and shoes, kids toys.... anything that could have remotely been bought with this stolen money and auction it all off to send back to Medicare and Medicaid.
Deb39, Fri, 10/17/2014 - 11:10
Greed is an ugly thing - stupid is equally ugly. When you defraud the government it WILL come back on you eventually. It took from 2009 till 2014 for this guy to get caught but now he will lose everything, hopefully, and he may even get some R&R at a federal prison. He is shamed and rightfully so, he will hopefully lose his license to practice what can legally be a lucrative profession. All because he got greedy. Shame shame shame. I hate to say it but he probably will get slapped on the hands and have to repay but suffer not much else.
I am SO freaking angry with this man because he was MY DR! Did his selfish GREEDY ass think one time about his hundreds of patients who were putting their mental health in his hands only to find out he needs more help than at least I did for the reason I was seeing him? Hell NO! I was only seeing him for anxiety and thank goodness my PCP will now take over my medication management because again, did Dr. Gross think for one minute about any of his patients? In particular, the ones way worse off than me that depended on him for medication refills and very severe mental illness', that as of last Wednesday morning had NO MORE DR to call upon if something ,God forbid, horrific had arisen in their mental health or had intentions of calling for a refill Wednesday morning and he was no longer there to issue that refill or admit them to a hospital? Hell no! This just turns my stomach! Why would a man who already has the education to make millions of dollars be so freaking greedy and put every single one of his patients BEHIND HIS OWN greed and selfishness. Did he really not learn to recognize mental illness? Even in himself? Because, he has been Sanctioned for fraudulent billing practices before! It used to show up on healthgrades.com, but enough time has passed that those records no longer show up on their site, but I have seen them and can probably be found if you knew where to look. Unfortunately Angelo has a severe shortage of Psychiatrists and there are only two in town now that see patients on an out patient basis. At least that is what I was told this morning, as I desperately searched for someone to take over my med management, by another shrink's receptionist who was the second one to tell me that neither of the ONLY two seeing out patients in Angelo are accepting new patients. Did Dr. Gross think about what all of his patients were going to do when his greedy dumb ass went to jail? HELL NO! I am so thankful my PCP is going to take over my med management. I feel so sorry for all the other patients he has crapped on and left all alone without refills or treatment they may desperately need because he couldn't learn his lesson the first time around! I was placed in the position of basically having to use him several years ago when my long time Psychiatrist left his private practice to only see his patients at Rivercrest. We already had a shortage of shrinks then and Dr Gross was the only one taking new patients. I do believe in giving people second chances, so I went with him. Thanks Dr Gross for stealing my money and millions of other people's money that the government barely puts into Medicare and Medicaid. So freaking sad to see you lose your probably thought hidden 3 million $$ and parcels of land all over the place. I only wish you could live 520 years to do that time in FEDERAL Prison! YOU DESERVE IT! And much more will probably be added to that because his office is still closed. I'm sure the Feds are in there now taking out all of his billing records for patients here and in surrounding areas and other Nursing Homes he saw in this area! You are a Piece of CRAP Dr Gross and you ARE GROSS! And Hell yes I am mad! How dare you???
Those who think he may get a slap on the hands, I am digging deeper into the past of this Dr that I trusted and getting sicker by the minute. I think a slap on the hands is NOT what he's going to get... Or I pray it's not. http://www.dallasobserver.com/1999-02-11/news/the-fugitive/
He should be jailed for years after taking away his license to practice and all his possessions. A disgrace to his profession.

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