Richard Toussaint, best known as a Dallas, Texas anesthesiologist and the co-founder of the recently-bankrupt hospital chain Forest Park Medical Center, was recently found guilty of seven counts of healthcare fraud and faces up to seventy years in prison.
Last May, Toussaint was indicted after investigators found that $10 million of false claims had been filed to many insurance companies, including, Blue Cross Blue Shield of Texas, UnitedHealthcare, and the Federal Employees Health Benefits Program. The scheme took place from 2009 to 2010, over an eighteen month period. The trial for Toussaint took just four days, and the federal jury spent only three hours deliberating before returning its verdict.
Toussaint was found to have billed for numerous procedures that he should not have billed for, as he was in another state or hospital, or even “undergoing surgery himself.” In order to fraudulently bill, he created fake medial records as if he had participated in face-to-face medical procedures and was physically present during the “most demanding and risky aspects of the anesthesia plan,” when in actuality, he was not. Court documents allege that not only would he sign his initials next to the claims, but if he wasn’t able to, he would direct others to do the same. Going a step further, Toussaint would also pre-sign patients’ medical records, representing that the services were provided and completed before the procedures even took place.
One of the red flags that caught Toussaint in this web was that his claims would sometimes overlap. One time, he billed for being present and medically directing six patients at two different hospitals. Also, as previously referenced, when he was under anesthesia himself, he filed claims for medically directing two patients.
The report also stated that when Toussaint was in the operating room, he would increase the amount of time it took to perform the procedures, and encourage/direct others to do the same.
While a sentencing date has not been set, Toussaint faces up to seventy years in prison (ten years for each of the seven counts) and a $1,750,000 ($250,000 for each of the seven counts) fine. Toussaint may also be forced to turn over several assets that were purchased using money from the fraud scheme – including eight luxury cars and any private aircrafts in his name.
His hospital chain, Forest Park Medical Center, has not been doing well, either. Just last month, the system filed for bankruptcy. The bankruptcy filing follows several physician kickback suit settlements over the past several years.
This indictment and subsequent guilty verdict are the most recent in a months-long string of similar cases. We bring these “horror stories” to our readers every now and then to serve as a reminder how important a thriving and successful compliance program is at every level in a company. This particular instance could have been avoided if the medical centers at which Toussaint practiced had strong compliance departments who could have noticed, for one, that Toussaint was billing for completing procedures when he was not present, or that he was billing for being present in overlapping procedures.
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