Caldwell Optometrist Sentenced for Defrauding Health Care Benefit Programs
Court Ordered $1 Million in Restitution, $100,000 Fine
BOISE – U.S. Attorney Wendy J. Olson announced today that Christopher Card, 60, of Caldwell, Idaho, was sentenced in United States District Court to 36 months in prison followed by three years of supervised release for executing a scheme to defraud health care benefit programs. U.S. District Judge Edward J. Lodge also ordered Card to pay $1 million in restitution and fined him $100,000. He pleaded guilty to the charge on August 16, 2012.
According to the plea agreement, on various dates between 1993 and August 31, 2010, Card, a licensed optometrist in Idaho and the former owner, manager and care provider at Total Vision, P.A., in Caldwell, 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 represent only a fraction of the 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.
“For years, Christopher Card defrauded Medicaid, Medicare and other healthcare benefit programs and diverted the funds to his own personal gain,” said Olson. “Nationally, health care fraud costs taxpayers nearly $252 per person, or $78 billion total, annually. Plainly, criminal conduct like this is a drain on our economy and on our health care resources. The significant sentence imposed by the Court was well deserved in this case.”
“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 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.
Today’s announcement is part of efforts underway by President Obama’s Financial Fraud Enforcement Task Force (FFETF), which was created in November 2009 to wage an aggressive, coordinated and proactive effort to investigate and prosecute financial crimes. With more than 20 federal agencies, 94 U.S. attorneys’ offices, and state and local partners, it is the broadest coalition of law enforcement, investigatory and regulatory agencies ever assembled to combat fraud. Since its formation, the task force has made great strides in facilitating increased investigation and prosecution of financial crimes; enhancing coordination and cooperation among federal, state and local authorities; addressing discrimination in the lending and financial markets and conducting outreach to the public, victims, financial institutions and other organizations. Over the past three fiscal years, the Justice Department has filed more than 10,000 financial fraud cases against nearly 15,000 defendants. For more information on the task force, visit www.stopfraud.gov.
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