San Angelo doctor indicted on 52 counts of health care fraud

Oct. 16--SAN ANGELO, Texas -- A San Angelo psychiatrist was indicted on charges that he defrauded Medicare and Medicaid of nearly $1.75 million, according to federal officials.

To view the indictment, please click here.

Robert Hadley Gross, 57, a licensed psychiatrist, was arrested at his San Angelo office Wednesday evening. He is scheduled to make an initial appearance before a U.S. Magistrate judge today in Abilene.

Federal investigators claim Gross submitted fraudulent claims for services rendered to nursing home residents in San Angelo and other communities in surrounding counties. He was indicted on 52 counts of health care fraud.

From approximately January 2009 to June 2014, Gross ran a scheme to defraud Medicare and Medicaid and other health insurance carriers by filing claims for payment for services that were never given and for services that were billed using inappropriate Current Procedural Terminology, or CPT, codes. This five-digit code dictates the amount of payment the provider receives for the rendered service.

Gross also allegedly submitted claims for services provided to clients of mental health and mental retardation organizations in San Angelo, Midland and Abilene. Also in 2009 and 2010, Gross allegedly submitted claims for services provided to foster care children in Brownwood.

"As part of his scheme, according to the indictment, Gross, for numerous dates of service, filed claims for services rendered which, for each of those dates, would entail Gross spending more time than his typical workday," according to a news release from the U.S. Attorney's Office, Northern District of Texas.

In "many instances" involving a nursing home, MHMR and office patients, Gross upcoded claims for services of patients with whom he had contact, the news release states, which resulted in a higher payment to his office.

Federal investigators claim Gross filed claims for services on dates he did not actually see patients. In those instances the patient may have been present at the nursing home at the time of his visit, or the patient may have died or been discharged before Gross' visit, the news release states.

An indictment is an accusation by a federal grand jury, and a defendant is innocent unless proven guilty. If convicted each of the 52 counts of health care fraud carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine.

Restitution may also be ordered. The indictment includes a forfeiture allegation that would require Gross, if convicted, to forfeit:

At least $1.75 million in a money judgment for the proceeds traceable to the commission of each offense.

Approximately $3 million in cash seized from various bank accounts in San Angelo and in Fort Washington, Pennsylvania, as well as from T. Rowe Price accounts.

Three parcels of real estate in San Angelo and Rockport, Texas.

The Federal Bureau of Investigation, Health and Human Services Office of Inspector General, and Medicaid Fraud Control Unit, Office of the Texas Attorney General are investigating. Assistant U.S. Attorney Ann Cruce-Haag is handling the prosecution, and Assistant U.S. Attorney John de la Garza is handling the forfeiture.

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