Texas clerk found guilty of overbilling worker’s comp program $5.5 million, DOJ says

A Texas woman was found guilty for her role in a health care scheme that bilked the government out of $5.5 million over six years, according to a U.S. Department of Justice news release.

Melissa Sumerour, 48, of Lorena, Texas, was found guilty by a federal jury on Friday of six counts of health care fraud for overbilling the U.S. Department of Labor Office of Workers’ Compensation Program, according to the news release.

Sumerour had been accused of overbilling the worker’s comp program for more physical therapy to patients than was actually provided -- at least $5.5 million in false claims -- from January 2011 to March 2017, the DOJ news release says.

A co-worker, Latosha Morgan, 42, of Grand Prairie, Texas, previously pleaded guilty in her role and is scheduled to be sentenced in March 2020.

The two women, while working as billing clerks at clinics in Waco and Temple, conspired to “unlawfully enrich themselves, by submitting, and causing the submission of false and fraudulent claims for health care benefits,” according to a DOJ indictment.

A medical doctor, referred to in the indictment as “Physician A,” reportedly paid Sumerour to “maximize billing by offering a bonus of their respective clinics’ weekly billing. The bonus was as much as 2 percent of the total amount billed and resulted in bonuses as large as $6,000 per month,” the indictment said.

U.S. District Judge Karen G. Scholer of the Northern District of Texas presided over the five-day trial.