The U.S. Attorney for the Northern District of Texas released the following statement this past week:
A federal jury has convicted two local men on conspiracy and health care fraud charges related to their operation of a physician house call company in North Texas, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
On October 4, 2013, following a five-day trial before U.S. District Judge David C. Godbey, Lawrence Dale St. John, 66, and his son, Jeffrey Dale St. John, 41, both of Grand Prairie, Texas, were convicted on conspiracy and health care fraud charges related to their operation of A Medical House Calls, a physician house call company.
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A Medical provided physician visits to Medicare beneficiaries in their homes rather than at a doctor’s office. A Medical, which was also known as A+ Medical House Calls and ANM Physician House Calls, was owned by Lawrence St. John; Jeffrey St. John ran its daily operations. A Medical had locations in Mesquite, Texas; Dallas; and Carrollton, Texas. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient.
Once A Medical established a Medicare beneficiary for physician home visit services, A Medical would submit billing for fraudulent care plan oversight claims. The company didn’t provide primary care physician services to Medicare beneficiaries.
According to documents filed in the case and evidence presented at trial, from May 2010 to January 2012, the defendants conspired together and with others to defraud the Medicare program. A Medical, at the direction of Lawrence and Jeffrey St. John, submitted claims to Medicare using Dr. Padron’s unique Medicare number, with Dr. Padron’s permission, regardless of the claim’s merit.
The defendants conspired together to bill Medicare for care plan oversight by Dr. Padron for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise.
In total, the defendants billed taxpayers for $1.4 million of services that were either not medically necessary or not rendered at all. Through the fraudulent certifications, Medicare was billed an additional $9.7 million by home health agencies.
The investigation was conducted by U.S. Department of Health and Human Services – Office of Inspector General, the FBI and the Texas Attorney General’s Medicaid Fraud Control Unit.
Assistant U.S. Attorneys Kate Pfeifle and J. Nicholas Bunch are in charge of the prosecution.
But what, if anything, was the impact on the patients whose Medicare information was misused in furtherance on the fraud conspiracy? Do their medical records now contain inaccurate information or have their records been amended to delete all phony entries? And did these services show up in EOBs sent to the patients? If so, did none of them check their statements or detect that A Medical had been paid for services not provided to them?
Fraudulent operations like A Medical or the RGV DME case also discussed on this blog often involved medical ID theft, yet these cases are unlikely to show up in HHS’s public breach tool as the fraudulent operations are not about to report they’ve been involved in breaching PHI.