Ten people, including two doctors, have been charged with $300 million in health care fraud, U.S. Attorney for the Northern District of Texas, Chad E. Meacham, announced.
The defendants – who are charged with conspiracy to commit healthcare fraud, conspiracy to pay and receive bribes for healthcare, offering or paying bribes -unlawful bribes and soliciting or receiving unlawful bribes – were charged in a 26-count indictment filed Wednesday afternoon.
“Anti-bribery laws are designed to ensure that financial considerations do not cloud doctors’ judgment,” said U.S. attorney Chad Meacham. “The Department of Justice is committed to prosecuting those who flout national health care fraud laws. Patients – and taxpayers – deserve strong enforcement.
“Illegal bribery schemes corrupt the healthcare system. They cause billions of dollars in losses each year, generate business for dishonest service providers, and erode trust in our health care system,” said Matthew DeSarno, FBI Dallas Special Agent in Charge. “The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes.”
According to the indictment, the founders of several lab companies, including Unified Laboratory Services, Spectrum Diagnostic Laboratory and Reliable Labs LLC, allegedly paid bribes to induce medical professionals to order lab tests. medically unnecessary, which they then billed to Medicare and other federal health care. programs.
Medical professionals – including internal medicine specialist Eduardo Canova, family doctor Jose Maldonado and nurse practitioner Keith Wichinski – are said to have accepted the bribes and ordered tests worth millions of dollars .
Meanwhile, Unified, Spectrum and Reliable disguised the bribes as legitimate business transactions, including medical advisor agreement payments, salary compensation, rental payments and marketing commissions.
The labs, through marketers, allegedly paid doctors hundreds of thousands of dollars for “advisory services” that were never performed in exchange for lab test referrals. They would also have paid part of the medical staff’s salaries and part of their office leases, based on the number of lab tests they referred each month. In some cases, lab marketers even made direct payments to the supplier’s spouse. (When labs threatened a vendor that payments would stop if it didn’t return more tests, it immediately increased its lab referrals, averaging about 20 to 30 referrals a day.)
Knowing they could conceal additional kickbacks by using a vendor ownership model, Spectrum and Unified founder Jeffrey Madison convinced Reliable co-founders Biby Kurian and Abraham Phillips to convert Reliable into a laboratory belonging to a doctor. Reliable offered physicians ownership opportunities only if those physicians referred a sufficient number of lab tests. In some cases, they made advance payments to doctors in an attempt to appease the doctor and ensure that he would not send samples to other labs.
As a result of these bribes, the labs controlled by the defendants were able to submit more than $300 million in bills to federal government health care programs. Between 2015 and 2018, Dr Maldonado alone received over $400,000 in kickbacks for ordering over $4 million in lab tests and Dr Canova received over $300,000 in bribes -de-vin for ordering more than $12 million worth of lab tests.
The defendants charged are:
• Jeffrey Paul Madison, 56, Founder of Unified Laboratory Services and Spectrum Diagnostics Laboratory
• Mark Christopher Boggess, 49, COO for Spectrum and Unified
• Biby Ancy Kurian, 49, co-founder of Reliable Labs, LLC
• Abraham Phillips, 50, co-founder of Reliable Labs, LLC
• Dr. Jose Roel Maldonado, 48, Laredo-based family physician
• Dr. Eduardo Carlos Canova, 44, internal medicine specialist based in Laredo
• Keith Allen Wichinski, 50, San Antonio-based certified nurse practitioner
• David Michael Lizcano, 56, owner of DCLH, a marketing company hired by Unified, Spectrum and Reliable
• Laura Ortiz, 58, sister of David Lizcano and employee of his marketing company
• Juan David Rojas, 34, owner of Rojas & Associates, another marketing company hired by Unified, Spectrum and Reliable
An indictment is only an allegation of criminal conduct, not evidence. Defendants are presumed innocent until proven guilty by a court.
If convicted, the defendants face up to 55 years or more in federal prison.
The Dallas Field Office of the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Investigations, the Defense Criminal Investigative Service, and the Office of the Inspector General of Veterans Affairs conducted the investigation. Assistant U.S. Attorney PJ Meitl is prosecuting the case.