Corporate Vice President Pleads Guilty to Healthcare Fraud Scheme
ATLANTA – Daniel K. Lane, Jr. has pleaded guilty to conspiring to commit healthcare fraud for filing fraudulent claims with Medicare, Blue Cross Blue Shield, and other insurers.
“This healthcare fraud scheme originated in the executive suite of Compass Healthcare and ended with the company filing thousands of false insurance claims,” said United States Attorney Sally Quillian Yates. “After cheating the insurers by getting them to pay for high-cost medical equipment never provided, the defendant papered up the fraud by sending in altered prescriptions with false patient diagnoses to support the claims. His business model was really a scam.”
J. Britt Johnson, Special Agent in Charge, FBI Atlanta Field Office, stated: “Leadership within the healthcare industry should be part of the cure, not the problem with respect to healthcare fraud related matters. The FBI will make every effort to focus its investigative resources and assets in identifying individuals such as Mr. Lane and presenting them for federal prosecution.”
"Protecting patients from unscrupulous billing practices and protecting the Medicare trust fund remains this agency's top priority," said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. "In addition to billing for services that were not provided, in some instances, this owner reported false diagnosis codes, making it difficult for the patients to subsequently obtain health insurance. Justice was well served in this instance."
According to United States Attorney Yates, the charges and other information presented in court: Daniel K. Lane, Jr. is the Vice President and Chief Financial Officer for Compass Healthcare, Inc., a durable medical equipment business headquartered in St. Louis, Mo., with offices in Atlanta, Ga., and other cities. Compass Healthcare specializes in providing compression stockings to patients who have been diagnosed with medical conditions such as chronic venous insufficiency and edema. Doctors may prescribe compression stockings, which come in different levels of tightness, as treatment for these conditions.
Lane’s position included responsibility for the billing of insurance companies for the compression stockings that Compass Healthcare provided to individuals who were covered by insurance. He fraudulently set up the company’s billing system so that in most instances it would automatically bill the insurers for the highest compression stocking, regardless of which stocking had actually been provided to the individual, in order to generate higher payments from Medicare, Blue Cross, and other insurers. As a result, Compass Healthcare routinely “upcoded” the claims it submitted to insurers for the stockings it had provided to individuals.
Lane conspired with an Office Manager for Compass Healthcare, Holly Keisker, and others to submit these false claims and conceal the fraudulent upcoding. Also as part of the scheme, Compass Healthcare included false diagnoses on its insurance claims to ensure payment. These false claims represented that Compass Healthcare customers had been diagnosed with various medical conditions, including chronic venous insufficiency and edema, to support the claims for high compression stockings, when in fact the customers had not been diagnosed by a doctor. Instead, Compass Healthcare used “blanket” diagnosis codes that were false to support insurance claims for compression stockings provided to customers who had no medical condition. Lane, Keisker, and others conspired to forge and alter doctors’ prescriptions so that they would support the fraudulent claims that had been submitted to insurers. They altered the prescriptions to falsely reflect that a high compression stocking had been prescribed and that the patient had been diagnosed with a medical condition. In 2011, Lane submitted altered prescriptions to Blue Cross in response to an audit conducted by the insurer.
Lane, 57, of St. Louis, Mo., pleaded guilty to one count of conspiracy to commit healthcare fraud. On September 19, 2013, Keisker, 61, of St. Louis, Mo., pleaded guilty to one count of conspiracy to commit health care fraud.
Sentencing for Lane is scheduled for November 19, 2014, at 10:00 a.m., before United States District Judge Willis B. Hunt, Jr.. Sentencing for Keisker is scheduled for December 10, 2014, at 10 a.m., before Judge Hunt.
This case is being investigated by Special Agents of the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, Office of the Inspector General.
Assistant United States Attorneys Stephen H. McClain and Jeffrey W. Davis are prosecuting the case.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the home page for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.