The U.S. Attorney for the Eastern District of Michigan announced on January 10, 2017 that a Detroit-area neurosurgeon was sentenced to 235 months in prison for his role in a $2.8 million health care fraud scheme in which he caused serious bodily harm to patients by performing unnecessary invasive spinal surgeries.
The 43-year-old neurosurgeon pleaded guilty to four counts of health care fraud, one count of conspiracy to commit health care fraud, and one count of unlawful distribution of a controlled substance, resulting in losses to Medicare, Medicaid, and various private insurance companies.
The neurosurgeon admitted in entering his guilty plea that he derived significant profits by convincing patients to undergo spinal fusion surgeries with instrumentation that he never performed and billed public and private healthcare benefit programs for those fraudulent services. He further admitted that he had operated on patients and dictated in his operative reports that he had performed spinal fusion with instrumentation in some instances when he had not, and that he knew that his operative reports would later be used to support fraudulent insurance claims.
Specifically, the neurosurgeon admitted that he fraudulently billed public and private health care programs for instrumentation when, in fact, he used cortical bone dowels made of tissue, and that he failed to render services in relation to lumbar and thoracic fusion surgeries, billing for implants that were not provided in certain instances.
How It Started, And Why It Continued
In approximately February 2010, the neurosurgeon invested in Apex Medical Technologies LLC (Apex), which was owned by another neurosurgeon and three non-physicians. The neurosurgeon agreed to convince his hospital to buy spinal implant devices from Apex and to use a substantial number of Apex spinal implant devices in his surgical procedures. The neurosurgeon admitted that he and Apex’s co-owners concealed his involvement in Apex from the hospitals and surgical centers.
The neurosurgeon admitted that the financial incentives provided to him by Apex and his co-conspirators caused him to use more spinal implant devices than were medically necessary to treat his patients in order to generate more sales revenue for Apex, which resulted in serious bodily injury to his patients. The neurosurgeon further admitted that the money he made from using Apex spinal implant devices motivated him either to refer patients for unnecessary spine surgeries or for more complex procedures that they did not need, on a few occasions.
In addition to the criminal health care fraud scheme, the neurosurgeon is a defendant in two civil False Claims Act cases brought by the Justice Department in the Central District of California, which are pending.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
Click here to visit our website or call us toll-free in the United States at 800-295-3959 to be connected with qui tam lawyers (False Claims Act lawyers) in your U.S. state who may assist you with a False Claims Act lawsuit.
Turn to us when you don’t know where to turn.