In last week’s enforcement actions involving the healthcare industry, the president of an Ohio-based radiology services company will spend 15 years behind bars after he was sentenced Sept. 29 for his role in an almost $2 million healthcare fraud scheme, according to the U.S. Department of Justice (DOJ). In addition to the prison sentence, Thomas G. O’Lear, 58, was also ordered to pay $1,989,490 in restitution to Medicaid, Medicare, and two Medicaid Managed Care Organizations (MCOs).
As part of the scheme, O’Lear billed these health insurance programs for “x-ray-related services that his company did not provide,” including claims for roughly 151 X-ray services “provided to patients on dates after the patients had died,” the DOJ said in a statement. O’Lear, whose company, Portable Radiology Services (PRS), offered X-ray services to those in long-term care and skilled nursing facilities, as well as those in nursing homes, also billed for supposed X-ray services provided to patients on dates when they were in hospital and not even in the facilities. In many cases, he also billed for several X-rays when only one was taken, or performed multiple X-rays during the same visit, but billed them as if they had each been done on different days, the DOJ stated.
In addition, O’Lear was convicted of covering up the fraud and committing aggravated identity theft by faking medical records and even X-ray images to hide evidence from a Medicaid MCO audit. O’Lear submitted a total of $3.7 million in false claims, of which he received about $2 million from Medicare, Medicaid, and the MCOs, according to the DOJ.1
Other Enforcement News
Sept. 27: A Northeast Indiana hospital network agreed to settle claims of overbilling Medicaid for $2.9 million. According to the Office of the Indiana Attorney General, several Parkview Health System hospitals used improper revenue codes when submitting claims to Medicaid for blood-clotting tests, resulting in the overbilling.2
Sept. 28: A Washington doctor pleaded guilty for his role in a genetic testing fraud scam that took advantage of elderly Medicare beneficiaries in that state, the DOJ said in a statement. The doctor, Christopher B. Bjarke, MD, 61, admitted in his plea agreement that he ordered genetic tests for patients that he had no physician-patient relationship with and was not treating at the time, apart from a brief telephone call arranged through telemarketers. Dr. Bjarke received a total of $167,996.73 in kickbacks from the scheme, and his fraudulent test orders led to $18.6 million in Medicare payments, the DOJ said in a statement.3
Oct. 3: Southeast Florida Hematology and Oncology Group (SEFHOG) settled kickback allegations for $130,000. According to the DOJ, the now-defunct medical practice was accused of violating both the False Claims Act and Anti-Kickback Statute “by receiving ‘upfront discounts’ from its specialty pharmaceutical distributor, Cardinal Health.” Cardinal Health had already settled allegations relating to these and other kickbacks for $13.125 million in January 2022.4
References:
- https://www.justice.gov/usao-ndoh/pr/president-radiology-services-company-sentenced-15-years-prison-2-million-healthcare
- https://events.in.gov/event/attorney_general_todd_rokita_and_team_achieve_29_million_settlement_in_medicaid_fraud_case
- https://www.justice.gov/usao-edwa/pr/renton-doctor-pleads-guilty-conspiring-accept-kickbacks-connection-fraudulent-genetic
- https://www.justice.gov/usao-ma/pr/florida-medical-practice-agrees-pay-130000-resolve-allegations-it-received-kickbacks