Dallas doctor and Forest Park co-founder guilty in $10M medical fraud scheme
Dr. Richard Ferdinand Toussaint Jr., who co-founded the Forest Park Medical Center system that has spiraled into bankruptcy, faces up to 70 years in prison after being found guilty of committing a $10 million health care fraud.
The Dallas anesthesiologist was convicted before U.S. District Judge Reed C. O’Connor on all seven counts he faced. He was found guilty of fraud on Thursday after a four-day trial in which government prosecutors accused him of submitting falsified payment claims to Blue Cross Blue Shield of Texas, UnitedHealthcare, the Federal Employees Health Benefits Program, Aetna, Cigna, Humana and other insurers.
Toussaint, 58, co-founded and once held a substantial ownership interest in Dallas-based Forest Park Medical Center. He also practiced at Doctors Hospital at White Rock Lake and started Ascendant Anesthesia in Dallas.
Toussaint faces up to 10 years in federal prison and a maximum $250,000 fine for each of the seven counts, according to a news release from the U.S. Attorney’s Office. He will also have to pay restitution, according to U.S. Attorney John Parker of the Northern District of Texas.
A sentencing date has not been set.
Toussaint filed claims for procedures conducted when he was out of state, at another hospital, flying in his private jet, or actually under anesthesia undergoing surgery himself, according to the U.S. Attorney’s Office.
The anesthesiologist fraudulently billed health care benefit programs about $10 million during an 18-month-long fraud spree in 2009 and 2010, according to the government.
“Toussaint submitted or caused to be submitted several claims representing he was present for and medically directing six patients at two different hospitals and was medically directing two patients while under anesthesia himself,” the press release from the U.S. Attorney’s Office says.
The government presented evidence that Toussaint also inflated the amount of time the procedures took and pre-signed patients’ medical records representing the services were provided before the procedures even took place. In addition to personally creating false medical records and inflating anesthesia procedure time, Toussaint directed others to do the same, representing he was present for procedures when he was not.
Toussaint started Ascendant Anesthesia “to monopolize anesthesia procedures at Forest Park Medical Center — a luxury hospital that he founded and owned,” court records said.
Toussaint received his medical degree from Southwestern Medical School in Dallas in 1983 and completed his anesthesia residency at Parkland Memorial Hospital, according to his online biography.
The financially-troubled Forest Park Medical Center chain has its flagship hospital in Dallas, as well as hospitals in Frisco, Fort Worth, Southlake and San Antonio. All have filed for Chapter 11 bankruptcy protection, and the Dallas and San Antonio locations are closed.
In an unrelated case, Forest Park Medical Center in Dallas paid $215,000 to the government last year to settle a case involving kickbacks in exchange for referrals of patients covered by the federal workers’ compensation program, according to the government.
In 2013, the Dallas hospital paid more than $258,000 to settle separate allegations that it paid kickbacks to area physicians for referrals of patients in a federal health insurance program for members of the military and their families.
Toussaint’s case was investigated by the FBI, the U.S. Department of Labor, the U.S. Postal Service, the U.S. Department of Defense, the U.S. Office of Personnel Management, the U.S. Department of Health and Human Services, the Food and Drug Administration, and Internal Revenue Service Criminal Investigation Unit. Assistant U.S. Attorneys Andrew Wirmani and Kate Pfeifle prosecuted the case. Assistant U.S. Attorney Mark Tindall is handling the forfeiture issues.
Originally posted on: bizjournals.com