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   San Angelo Doctor Charged with 52 Counts of Health Care Fraud    
      
      
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   by Chelsea ReinhardOct 16, 2014    
      
   San Angelo doctor Robert Hadley Gross has been charged with health care fraud.   
   (Contributed Photo/TGCJ)    
      
   In Brief:    
   U.S. Attorneys Office press release    
      
   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.    
      
      
      
   http://sanangelolive.com/news/san-angelo/2014-10-16/san-angelo-d   
   ctor-charged-52-counts-health-care-fraud   
      
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