AUSA VICKIE E. LEDUC at 410-209-4885
November 22, 2005
COMPLAINT FILED AGAINST TOWSON DOCTOR FOR FALSE CLAIMS
Doctor Allegedly Filed Fraudulent Claims for Cosmetic Procedures
Baltimore, Maryland - United States Attorney for the District of Maryland Rod J. Rosenstein announces that today the United States filed a complaint against David C. McCarus, M.D., age 54, an OB/GYN practicing in Towson, Maryland, for violations of the False Claims Act arising from false claims McCarus submitted to Medicare, the Federal Health Employees Health Benefits Program (“FEHBP”) and TRICARE. The complaint seeks damages in the amount of $583,717.83 plus penalties ranging from $5,500 to $11,000 for each of 267 alleged false claims submitted by McCarus to Medicare, the FEHBP and TRICARE.
United States Attorney Rod J. Rosenstein said, “Doctors who defraud federal health plans are cheating all taxpayers. The False Claims Act allows us to hold them accountable by recovering triple the amount of damages, plus additional penalties.”
The complaint alleges that McCarus devised a fraudulent scheme in which he billed Medicare Part B, TRICARE and the FEHBP for the treatment of cosmetic conditions such as varicose veins, spider veins, facial hair (hirsutism), rosacea (redness or flushing of face), hemangiomas (tiny red spots), telangiectasia (broken veins on face), bikini lines, skin tags, stretch marks and scars with the use of Intense Pulsated Light (IPL), YAG Laser or Eplight, as if the treatments were covered medical services when in fact all of the conditions that he treated were cosmetic, non-covered and non-reimbursable services.
The complaint further alleges that McCarus perpetrated this fraud by engaging in a pattern of falsely diagnosing patients with reimbursable medical conditions, as opposed to the actual cosmetic conditions that each patient had, to make it appear as if treatment of the cosmetic condition was, in fact, a covered service. McCarus allegedly then billed for these cosmetic services using CPT code 17108, which is designed to cover the “destruction of vascular and proliferative lesions,” not the treatment of cosmetic conditions. The complaint also alleges that McCarus further committed fraud by grossly and fraudulently inflating the size of the area on the skin that he allegedly treated in order to substantially increase his reimbursement under CPT code 17108.
Enacted during the Civil War, the False Claims Act is the government’s primary civil tool to combat fraud and abuse in federal programs and procurement. The Act allows the government to recover triple the amount of its actual damages, plus a civil penalty of $5,500 to $11,000 for each false claim.
United States Attorney Rod J. Rosenstein commended the investigative work performed by the Department of Health and Human Services Office of the Inspector General and the Office of Personnel Management Office of Inspector General. Mr. Rosenstein also thanked Assistant U.S. Attorney Thomas F. Corcoran, who is handling the case.