July 15, 2011
Department of Justice
United States Attorney William C. Killian Eastern District of Tennessee
PHYSICIAN RECEIVES ONE YEAR PRISON SENTENCE FOR HEALTH CARE FRAUD AND TAX OFFENSES
KNOXVILLE, Tenn.--Allen R. Foster, M.D., 49, a resident of Gatlinburg, Tenn., who previously practiced medicine in the Morristown and Knoxville areas, was sentenced today by the Honorable Thomas W. Phillips, U.S. District Judge, to serve one year in federal prison, followed by three years of supervised release. Foster was also ordered to pay restitution to Medicare in the amount of $74,307 and to TennCare in the amount of $65,837. Additionally, Foster was ordered to pay $596,761.07, in restitution to the Internal Revenue Service (IRS). This sentence follows Foster's February 22, 2011, guilty pleas to health care fraud and tax related offenses. Pursuant to the plea agreement, Foster also agreed to surrender his license to practice medicine to the Tennessee Board of Medical Examiners.
On February 2, 2011, U.S. Attorney William C. Killian filed an information in U.S. District Court charging Foster with engaging in a scheme to defraud Medicare and TennCare by fraudulently billing those health care benefit programs for 15-minute office visit codes for "fast-track" patients who actually did not have a 15-minute office visit encounter with a provider at Foster's practice. Foster was also charged with a criminal tax offense arising from his failure to file a tax return for the calendar year 2005.
According to court documents Foster admitted that in 2006 and 2007, he practiced medicine in Morristown and Knoxville, operating his medical practice under various names including Advanced Pain Therapeutic, P.C., Fosterkare Anesthetist Associates, P.C., FKA Pain Management, and AF Pain Management. During that time, Foster's medical practice employed a system known as the "fast-track" system as a way to coordinate his medical practice’s high volume of established patient office visits. Under this fast-track system, Foster's established pain management patients were provided prescriptions during monthly visits without having a face-to-face encounter with a licensed provider, that is a physician, physician assistant or nurse practitioner.
Even though no 15-minute face-to-face encounter occurred between a fast-track patient and one of Foster's providers, Foster still caused every fast-track patient encounter to be submitted and billed to Medicare and TennCare as an office visit billing code that anticipated a 15-minute office visit, which paid a higher reimbursement rate than a billing code for an office visit that did not include a face-to-face encounter with a provider.
"Health care fraud hurts all Americans by wasting precious taxpayer dollars on claims for services that are medically unnecessary, or as in this case, were never even provided," said U.S. Attorney Bill Killian. He further added, "The U.S. Attorney's Office, working together with its law enforcement partners at the Tennessee Bureau of Investigation, Federal Bureau of Investigation, and Health and Human Services, Office of Inspector General, will continue to aggressively investigate and prosecute health care fraud crimes in the east Tennessee community."
As for the tax offense charged in the information, court documents also show that Foster admitted that during the 2005 tax year, he worked by contract for various hospitals and owned and operated a financially successful medical practice located in Morristown, Tenn. Based on his gross income that year, he was obligated to file an income tax return, but failed to timely file a tax return.
This case was investigated by the Tennessee Bureau of Investigation, Federal Bureau of Investigation, Health and Human Services, Office of Inspector General, and the IRS- Criminal Investigation. Assistant United States Attorney Trey Hamilton represented the United States.