The US Attorneys Office in Baton Rouge, Louisiana scored a major victory against a Baton Rouge doctor for submitting false Medicare claims. The doctor entered a guilty plea of conspiracy to commit health care fraud involving several millions of dollars. The doctor has not yet been sentenced but will most likely face jail time. The case was prosecuted in federal court rather than state court, presumably because Medicare claims were involved.
According to law enforcement officials, the doctor operated a spinal and pain management clinic. For nearly 10 years, the clinic had submitted bills for patient procedures when the patient was not in the clinic. In other cases, employees were instructed to falsify medical records so it would appear the procedures were consistent with billings. The claims total over four million dollars over the 10 year period. The criminal practices seem to be submitted to Medicare in the majority of cases, but private health insurance companies were also victimized.
Another employee of the clinic also pled guilty to health care fraud, conspiracy to commit health care fraud and the additional charge of wire fraud. Two other doctors from the clinic pled guilty last fall to claims of receiving health care kickback payments and illegal distribution of oxycodone.
Numerous law enforcement agencies were involved in the investigation, including the FBI, the Medicare Fraud Task Force, the Inspector General’s Office and the Department of Justice’s Fraud Division.
Those seeking to submit a false claim to Medicare or other health care insurer should understand the criminal sanctions involved. A number of federal and state laws can be used for prosecution. Most have the potential for incarceration and substantial fines. Those accused of such a crime might benefit from seeking the services of a competent criminal defense attorney experienced in white-collar crime defense.
Source:wafb.com”Louisiana Spine &Sports Doctor accused of $4.4M Medicare scheme pleads guilty,” Kevin Foster, February 14, 2019