Two suspects were arrested after the U.S. Attorney’s Office said they submitted and caused the submission of more than approximately $5.9 million in false and fraudulent claims to FECA.
According to U.S. Attorney’s Office Public Affairs Office Daryl Fields, beginning in January 2011 and continuing until about March 2017, defendants Melissa Sumerour and Latosha Morgan did knowingly and willfully conspire with each other and others to commit health care fraud in the Northern District of Texas.
In the criminal complaint, physician A was a licensed medical doctor in Texas who owned and operated three medical clinics in Temple, Waco and Fort Worth. Sumerour was an office administrator and biller for the Waco and Temple clinics.
The clinics only treated OWCP patients.
According to Morgan’s interview, Sumerour instructed other office staff on billing procedures at the clinics in CTX.
Physician A incentivized Sumerour to maximize billings by offering a bonus of over $50,000 in a week. The bonus for Sumerour was one percent of the total billed to OWCP.
Physician A, Sumerour and Morgan billed through a code that paid half off the amount for the service. In the reports, it says that a physician drafted it, but non-medical clinic staff drafted the reports and not physician A.
Sumerour taught Morgan to change billing submitted by licensed medical professionals in order to maximize the billing for each service and for services that did not occur.
Sumerour also billed and instructed others to bill for physical therapy services purportedly conducted at the clinics regardless of what services were actually completed.
She instructed a Waco clinic manager to always bill five units of therapeutic activities, five units of therapeutic exercises and four units of manual therapy, regardless of how much physical therapy was actually completed by the patient.
From January 1, 2011, through March 30, 2017, physician A, Sumerour and Morgan submitted and caused the submission of more than approximately $5.9 million in false and fraudulent claims to FECA.
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