The former CEO of Palo Pinto General Hospital in Mineral Wells, Texas, has pleaded guilty to defrauding BlueCross BlueShield of Texas, Cigna Texas and UnitedHealthcare out of millions of dollars, according to the Department of Justice.
According to court documents, Harris Brooks and his co-conspirators submitted claims to in-network insurance companies for genetic and allergy testing that was purportedly performed at Palo Pinto General Hospital. However, the hospital did not have the equipment to perform the tests, and patients actually received treatment at various clinics throughout Texas and in other states.
The pass-through billing scheme lasted from September 2017 through June 2018. During that time, Mr. Brooks and his co-conspirators submitted more than $55 million in claims, most of which were fraudulent, to insurers for laboratory services. The insurers paid the hospital more than $9 million for the claims.
Mr. Brooks faces up to five years in prison and will be required to pay restitution, according to the Justice Department.
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