Clinic Manager Heads to Prison for Health Care Fraud
HOUSTON – The 47-year-old owner and operator of Elite P.
Care Medical Services has been sentenced for her role in a health care fraud
conspiracy that billed Medicare and Medicaid for more than $1 million in
fraudulent health care claims, announced U.S. Attorney Kenneth Magidson.
Verona Spicer, of Houston, pleaded guilty to conspiracy and
health care fraud charges in October 2015. Today, she was ordered to federal
prison for 33 months.
Spicer had clinics located on Harwin Drive in Houston and in
Port Arthur. She submitted claims to Medicare and Medicaid that fraudulently
billed for physician office visits not performed by a licensed physician,
physical therapy services not provided or performed by a licensed physical
therapist and medical diagnostic tests not ordered as medically necessary by a
Spicer paid Houston physician Dr. Jocelyn Pyles, 59, of
Sugar Land, who formerly worked full-time as a physician for the City of
Houston. After completing her work for the City of Houston, would go to
Spicer’s clinics where she signed patient medical records for patients she had
not seen or examined. Spicer and Pyles signed Medicare and Medicaid enrollment
applications that enabled the fraudulent billing under Pyles’ Medicare and
Medicaid provider numbers.
A foreign medical graduate who was not licensed to practice
medicine in the United States was actually the person who saw the patients.
Pyles was also ordered to prison after a jury convicted her
of 14 counts of health care fraud in November 2015.
Spicer and Pyles were both also ordered to pay Medicare and
Medicaid $560,718.62 in restitution.
The Department of Health and Human Services – Office of
Inspector General, FBI, Texas Attorney General’s Medicaid Fraud Control Unit
conducted the investigation with assistance of Medicare Zone Program Integrity
Contractor, Health Integrity LLC. Assistant U.S. Attorney Julie Redlinger
prosecuted the case.