A federal jury convicted a Cleveland doctor on Monday of conspiracy to commit healthcare fraud following a two week trial for his role in referring and certifying patients to hospice who were not terminally ill and should not have been placed on hospice care.
According to court documents and evidence presented at trial, Dr. Scott Nelson, of Cleveland was a medical director for numerous hospice organizations in the Mississippi Delta.
At least four of the hospice owners associated with Dr. Nelson had been convicted of healthcare fraud prior to Dr. Nelson’s trial. Hospice employees routinely transported prospective patients to Dr. Nelson’s office in Cleveland, sometimes transporting three or four patients at a time. Dr. Nelson saw the patients in his office and then referred them for hospice, claiming to be their primary care physician, or attending physician. In almost all cases, the patients had no idea they were being placed on hospice and multiple patients testified at trial that Dr. Nelson did not explain hospice to them and did not tell them he was referring them to hospice care.
Dr. Nelson also certified patients as terminally ill who were not actually terminally ill and he “robosigned” numerous medical records, allowing hospice owners to bill Medicare and Medicaid for hospice services that were not medically necessary. From 2009 through 2014, Dr. Nelson served as medical director for as many as 14 hospice providers and received approximately $442,000 in medical director fees from those hospices.
“This type of fraud drives up medical costs for those who truly need care and jeopardizes our entire healthcare system.” said U.S. Attorney Clay Joyner. “The U.S. Attorney’s Office will continue to work with all federal, state and local partners to do everything in our power to eradicate it.”
During the course of the conspiracy charged in the indictment, hospice owners received over $15 Million in Medicare funds based on Dr. Nelson’s patient referrals and certifications.
Prior to the trial, co-defendants Charline Brandon, Wendell Brandon, and Annette Lofton all pled guilty to the conspiracy to commit healthcare fraud.
”Just to enrich himself, Dr. Nelson fraudulently prescribed hospice care for a steady stream of Medicare and Medicaid beneficiaries who he knew were not dying, ignoring the fact that under this end-of-life status they would not be eligible for curative services,” said Special Agent in Charge Tamala E. Miles of the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG). “The guilty verdict in this case shows that our investigators and our law enforcement partners will aggressively pursue irresponsible practitioners who put their greed for profits above the well-being of their patients.”
“Healthcare fraud is not just about the dollars these medical professionals have taken, but also the trust they have violated,” said Mississippi Attorney General Lynn Fitch. “Patients put their faith in their doctors. They should not have to worry about being pawns in a get-rich-quick scheme. My Office is pleased to work with our partners at the U.S. Attorney’s Office to protect patients and defend the sacred trust so essential to our healthcare system.”
The HHS-OIG and the Mississippi Attorney General’s Medicaid Fraud Control Unit are investigating the case. The case is being prosecuted by Assistant U.S. Attorneys Clay Dabbs and Kim Hampton.