Last week was slow in terms of enforcement actions related to labs, with only one case touching on lab testing. In that case, a woman was sentenced to prison for posing as a licensed physician’s assistant at a Georgia-based family practice. During the time she was employed at the practice, she not only ordered lab work and diagnostic tests, but also diagnosed illnesses, treated patients, and wrote prescriptions in a physician’s name without that doctor’s permission.
Three other healthcare-related cases offer important lessons to labs on both Stark and False Claims Act (FCA) violations. In one case, Sibley Hospital and its parent company, Johns Hopkins Health System, paid $5 million to settle claims of violating the Stark Law, while Meharry Medical College and behavioral health clinician group K-Assist, LLC, and its owner settled separate FCA-related claims for just over $100,000 and just over $234,000, respectively.
In a fifth case, a marketer from South Florida was sentenced to prison for buying and selling more than 2.6 million Medicare beneficiary identification numbers, as well as other personal identifying information.
Key Healthcare-Related Enforcement Actions Announced from April 12 – April 19, 2023
| Date Action Announced | Defendant(s) | Allegations/Charges/Convictions | Result |
| April 11 | Charles William McElwee | South Florida man had earlier pled guilty to one count of conspiracy related to collecting Medicare beneficiary numbers and other identifying information such as names and addresses via “social engineering techniques” and “data mining” with his co-conspirators. McElwee then advertised and sold the information online. His case is one of the first prosecuted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which makes it illegal to buy, sell, or distribute Medicare or Medicaid beneficiary numbers without the proper authority. | Sentenced to 41 months in prison1 |
| April 17 | Meharry Medical College | The Nashville-based medical college is accused of violating the FCA by billing Medicare for psychiatric, OB/GYN, and internal medicine services “performed by unsupervised, non-physician residents.” | Settled for $100,749 and must also implement a billing policy and annual training for faculty and first-year residents to ensure compliance2 |
| April 17 | · Sibley Hospital · Johns Hopkins Health System (parent company) | Allegedly violated the Physician Self-Referral Law (Stark Law) by billing Medicare for services referred by 10 cardiologists whom the hospital paid above-market compensation to. This alleged improper financial arrangement had been self-disclosed by the defendants. | Settled for $5 million3 |
| April 18 | Theresa Pickering | Posed as a licensed physician’s assistant and was hired for this role at a Georgia-based family practice in 2019, though she was unlicensed at the time and hadn’t been licensed in any US state since March 2014. Pickering previously served a prison sentence for an earlier case in which she also posed as a licensed physician’s assistant in Mississippi. During her employment in Georgia, Pickering caused at least around $147,000 worth of fraudulent claims to both Medicare and private payers. | Sentenced to two years and nine months in federal prison, followed by three years of supervised release. Pickering must also pay $48,742.30 in restitution.4 |
| April 18 | · Kelly Stutzman (owner) · K-Assist, LLC | New Haven area behavioral health clinician group and its owner, Kelly Stutzman, were accused of violating the FCA for billing Medicaid for psychotherapy services rendered by an unlicensed individual. Stutzman also pled nolo contendere to health insurance fraud in a separate state criminal proceeding. | · FCA allegations settled for $234,064.89 · As a result of the state criminal proceeding, Stutzman must pay $63,764.23 in restitution and serve a three-year suspended jail sentence and five-year conditional discharge5 |
References:
- https://www.justice.gov/usao-sdfl/pr/south-florida-marketer-sentenced-prison-term-buying-and-selling-over-26-million
- https://www.justice.gov/usao-mdtn/pr/meharry-medical-college-agrees-settle-false-claims-act-allegations
- https://www.justice.gov/opa/pr/sibley-hospital-and-johns-hopkins-health-system-settle-allegations-improper-compensation
- https://www.justice.gov/usao-ndga/pr/former-physicians-assistant-sentenced-health-care-fraud-after-posing-licensed
- https://www.justice.gov/usao-ct/pr/connecticut-behavioral-health-clinician-group-pays-234k-settle-false-claims-allegations