A 46-year-old Palm Beach County doctor has been arrested and charged with healthcare and wire fraud after being accused of billing for unnecessary medical care and treatment for substance abuse patients for many years.
The man is accused of running a billing scheme from May 2011 through March 2020. He allegedly billed private insurance companies and Medicare $681 million for lab tests and various other services. A total of approximately $121 million was paid out by the companies.
The Department of Justice claims that the doctor exploited vulnerable patients looking to gain treatment for serious problems. They claim the doctor’s greed clouded his Hippocratic Oath and that he should be held accountable for his alleged criminal conduct.
The doctor owned a private health care clinic in Delray Beach that offered urgent care, family care, substance abuse treatment, and other healthcare services.
In a criminal complaint filed Thursday, the doctor is accused of playing a central role in the alleged healthcare fraud scheme.
He allegedly agreed to become the medical director for a substance abuse treatment center/sober home for a fee, authorized unnecessary urinalysis tests (UAs) that were billed by labs that sometimes paid kickbacks to treatment centers, and required facilities that needed his signature for these UAs to have their patients treated at his private clinic so he could bill for numerous other fraudulent treatments.
The complaint claims that the doctor served as medical director for more than 50 substance abuse treatment centers and signed over 136 orders for fraudulent tests.
He is further accused of billing some patients for $10-$20,000 for a single day’s visit. He allegedly used several nurse practitioner’s to fraudulently bill private insurance and prescribed patients he was not authorized to treat with large quantities of controlled substances.
The National Healthcare Anti-Fraud Association estimates that healthcare fraud costs the U.S. $68 billion every year, which is about 3% of America’s $2.26 trillion budget for health care spending. With that said, insurance companies spend lots of money to pay investigators to go over medical claims to snuff out any cases of fraud. Once an investigator uncovers any alleged fraud, they turn their information over to police to take over prosecution. The majority of these cases are for billing fraud, just like this case. Billing fraud is when a doctor bills for unnecessary services or for services that were never actually performed. A doctor accused of healthcare fraud stands to face criminal prosecution that could result in prison time and the loss of their license from the Florida Medical Board.
If you are a doctor that has had a search warrant issued for patient records, our Palm Beach County White Collar Criminal Defense Lawyers at Whittel & Melton can provide you with a free and confidential consultation that can help you better understand what happens next in these cases. As former prosecutors, we know very well how to protect doctors as well as other medical professionals from claims of healthcare fraud.
Insurance fraud and Medicare or Medicaid fraud may involve the following:
- Billing both private insurance or Medicare or Medicaid for tests or procedures that were never actually performed
- Ordering unnecessary tests for patients
- Falsifying information on patients medical records
- Billing for more tests than the patient needs
- Double billing for any treatment provided
- Prescribing medications that are not needed by the patient
- Billing for emergency care that was never provided
Healthcare fraud cases are taken very seriously and the investigations are usually quite lengthy. Once a search warrant is executed, it can take a significant amount of time before criminal charges are filed. This is why you want to retain legal help right away. Early intervention can be critical in these cases and could be the difference between you walking away with your freedom or spending time behind bars. Your medical career and freedom rely heavily on the defense strategy your criminal defense attorney will prepare for you.