METAIRIE DOCTOR SENTENCED FOR RECEIVING MATERIALS DEPICTING THE SEXUAL EXPLOITATION OF MINORS AND HEALTH CARE FRAUD; LOCAL HEALTH CARE BILLING COMPANY ALSO SENTENCED FOR COMMITTING HEALTH CARE FRAUD
DAN JOACHIM, M.D., age 52, a resident of Metairie, Louisiana, was sentenced today to serve six (6) years in prison before U. S. District Judge Martin L.C. Feldman after previously pleading guilty as-charged to receiving materials involving the sexual exploitation of minors and health care fraud, announced U. S. Attorney Jim Letten. JOACHIM was further ordered to repay $5,000 in restitution and sentenced to five (5) years of supervised release after his term of imprisonment ends. PHYSICIANS ANALYTICAL SERVICES, INC. (“PAS”), a Maryland corporation that pleaded guilty to the same count of health care fraud, was sentenced to repay $500,000 in restitution and was also placed on one (1) year of probation.
According to court documents, JOACHIM used multiple computers connected to the Internet to search for and download images of child pornography on a variety of websites. A forensic search of one such computer revealed that JOACHIM downloaded from the Internet and stored approximately152 images and 5 videos of children as young as six months old being forced to engage in a variety of sexual activity with adults and animals. JOACHIM organized the images in folders he created on his computer.
Additionally, beginning in or about 2004, and continuing until in or about April 2010, JOACHIM worked as the Medical Director of a Maryland company called Intra-Op Monitoring Services, Inc (“IOM”). IOM employed physicians to remotely monitor, through the use of an internet connection, neurophysiological surgical procedures performed at hospital and surgical suites. An IOM-employed technician, meanwhile, was present in the operating suite to communicate with the telemonitoring physician. For the telemonitoring of a surgery to be legitimately billed, the in-suite technician had to be in contact with a physician, and the physician had to be available in real time to interpret the data via the web-based interface. Further, the monitoring physician had to be able, in real time, to convey the interpretation to the technician, who could relay the information to the surgeon. In addition to his responsibilities as Medical Director, JOACHIM also was supposed to monitor surgeries. PAS was a wholly owned subsidiary of IOM and was responsible for billing-related matters.
PAS fraudulently billed various health care benefit programs for monitoring services that IOM-employed physicians did not provide and routinely overbilled for those monitoring services that were provided. In particular, PAS and other billing companies billed for telemonitoring services that did not occur. Often the connection did not exist between the technician and the monitoring physician. Other times, technical difficulties prevented the physician from monitoring most, or all, of the surgery. Additionally, PAS would bill insurers non-physicians would log onto the monitoring software using a physician's log-in information, including the log-in information of JOACHIM, and pretend to be a physician, and monitor surgeries in the place of physicians.
PAS also regularly upcoded the billing by representing that surgeries were being monitored for longer periods of time than the CPT codes permitted. For example, CPT codes provided for bills to be submitted for monitoring that took place between the time at which an electrophysiologic “baseline” was established and the ”closing” of the surgery. PAS, however, would routinely bill time spent prior to the establishment of a baseline, such as introducing the patient's history to the monitoring physician, or after the closing.
When insurers denied PAS’ requests for payment, the company routinely appealed those denials. In doing so, PAS frequently claimed that the rejection of the claim was "inappropriate and unjust," even though PAS was well aware that the claims submitted were false and fraudulent in that they represented the surgeries had been monitored in real time by physicians employed by IOM when PAS well knew that the surgeries had not been so monitored.
A portion of this case was brought as part of Project Safe Childhood, a nationwide initiative to combat the growing epidemic of child sexual exploitation and abuse launched in May 2006 by the Department of Justice. Led by United States Attorneys’ Offices and the Criminal Division's Child Exploitation and Obscenity Section (CEOS), Project Safe Childhood marshals federal, state and local resources to better locate, apprehend and prosecute individuals who sexually exploit children, and to identify and rescue victims. For more information about Project Safe Childhood, please visit www.usdoj.gov/psc. For more information about internet safety education, please visit www.usdoj.gov/psc and click on the tab “resources”.
This case was investigated by special agents from the Federal Bureau of Investigation the United States Department of Health and Human Services, Office of the Inspector General; and the United States Office of Personnel Management, Office of the Inspector General. The prosecution of this case is being handled by Assistant United States Attorneys Patrice Harris Sullivan and Jordan Ginsberg.
If you believe you have been a victim of fraud from a person or an organization soliciting relief funds on behalf of storm victims or have knowledge of waste, abuse, or allegations of mismanagement involving disaster relief operations, contact the National Center for Disaster Fraud toll free at: (866) 720-5721. You can also fax information to: (225) 334-4707 or e-mail it to: firstname.lastname@example.org