Caldwell Optometrist Pleads Guilty to Defrauding Health Care Benefit Programs
Parties Agree to $1 Million in Restitution
BOISE – Christopher Card, 59, of Caldwell, Idaho, pled guilty in United States District Court today to a superseding information charging him with one count of executing a scheme to defraud health care benefit programs, U.S. Attorney Wendy J. Olson announced. Card is a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell.
According to the plea agreement, on various dates between 1993 and August 31, 2010, Card executed a scheme to defraud Idaho Medicaid, Medicare, Blue Cross of Idaho, Regence Blue Shield of Idaho, and the Rail Road Retirement Board (RRB), by making false statements, and by submitting false, fraudulent, and fictitious claims for reimbursement to these health care benefit programs. The total loss to the health care benefit programs and the restitution agreed to by the parties is $1 million.
According to the plea agreement, Card fraudulently billed health care benefit programs, especially Medicaid and Medicare, for false diagnoses, including glaucoma, acquired color deficiency (color blindness), tension headaches, macular degeneration, treatment of eye injuries and removal of foreign objects from the eye. Card billed for testing that did not actually occur and for testing results that were falsified or altered. He admitted that in late October 2008, he altered his fraudulent diagnoses and billing practices when he learned that federal and state health care fraud investigators interviewed a former employee.
According to the plea agreement, 18 patients identified in the original indictment were diagnosed by Card with glaucoma or glaucoma-related conditions. All were subsequently examined by other doctors; only one was determined to actually have the glaucoma or glaucoma related diseases that Card had diagnosed. Card falsely diagnosed the 18th patient, and others, with acquired color deficiency. According to the plea agreement, the patients named in the original indictment were not the only patients for whom Card falsely billed health insurance companies.
The Medicaid program is a Idaho state-administered health insurance program that is approximately 70%, funded by the U.S. Department of Health and Human Services (HHS). The Idaho Medicaid program is a cooperative federal-state program that furnishes medical assistance to the indigent. The program helps pay for reasonable and necessary medical procedures and services, including optical services, to individuals deemed eligible under federal-state low-income programs. Medicare is 100% federally funded and is administered by the Centers for Medicare and Medicaid Services (CMS). Medicare pays for reasonable and necessary medical procedures and services, including vision services. Medicare covers, among others, individuals who are 65 years of age and older.
“Health care providers who submit false billings steal taxpayer dollars and unnecessarily strain our health insurance system,” said Olson. “Their greed drives up the cost of premiums and burdens others. In this case, the defendant's false diagnoses also caused unnecessary emotional stress for patients falsely diagnosed with glaucoma, an eye disease that can result in blindness. I commend the dedicated and thorough investigators who worked cooperatively to identify this fraud.”
“HHS-OIG is committed to protecting the integrity of the Medicare program and we will continue to work with the Department of Justice to seek those who exploit their patients for financial gain,” said Ivan Negroni, Special Agent-in-Charge of the San Francisco Region for the United States Department of Health and Human Services, Office of Inspector General. “We will continue to ensure that those who choose to defraud the Medicare program are held accountable.”
The charge of executing a scheme to defraud a health care benefit program carries a maximum term of 10 years in prison, a fine up to $250,000, or the greater of twice the gross gain or twice the gross loss resulting from the offense, and up to three years of supervised release.
Card is scheduled to be sentenced on October 30, 2012, before U.S. District Judge Edward J. Lodge at the federal courthouse in Boise.
The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, and the Idaho Attorney General Medicaid Fraud Control Unit.
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