Money Judgment Rendered Against Aberdeen Podiatrist for Violations of the False Claims Act

United States Attorney for the District of South Dakota, Brendan V. Johnson, announced today that a money judgment in the amount of $241,916.68, was rendered in Federal District Court on April 16, 2012, against Aberdeen podiatrist, Todd R. Monroe, and his professional corporation, Monroe Healthcare Innovations, Inc., and in favor of the United States, for violations of the False Claims Act (31 U.S.C. §§ 3729-3733).

In August 2010, Monroe pled guilty to Making False Statements Relating to Healthcare Matters in violation of 18 U.S.C. § 1035 and was ordered to make restitution to Medicare. This money judgment is the result of the civil counterpart to the previous criminal case.

An audit conducted by the agency responsible for oversight of the Medicare program initially identified concerns about Monroe’s billing practices. Several Medicare eligible patients were interviewed, and in each case, Monroe rendered routine non reimbursable services, such as cutting toe nails or removing corns or calluses, then falsified the patient’s medical record and improperly billed Medicare for surgical procedures.

The False Claims Act provides that parties who voluntarily disclose violations are liable for double damages, instead of triple damages, and civil penalties between $5,500 and $11,000 for each violation. This judgment resolves the False Claims Act liability for Monroe’s health care fraud, including triple damages, penalties, and investigative costs recovered on behalf of Medicare.

The U.S. Attorney’s Office places a high priority on criminal and civil enforcement in cases involving health care fraud, as well as related activities such as fraud against the elderly, prescription drug fraud, false billings, violations of the Anti-Kickback Statute, and other schemes that victimize patients, health care providers, private insurers, and government insurers such as Medicare and Medicaid. The office works with various law enforcement agencies to identify and investigate these matters, including the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation, the Internal Revenue Service, the Drug Enforcement Administration, and the South Dakota Attorney General’s Medicaid Fraud Control Unit. This matter was handled by Assistant United States Attorneys Kevin Koliner, Robert Gusinsky, Cheryl Schrempp DuPris and healthcare fraud auditor, James Flanigan.

For years, Medicare carriers have been required to send explanations of benefits to Medicare patients. It is critically important that all patients review and verify the information on these documents–and that they question any statements that are inconsistent with the actual health care services provided. In particular, be especially attentive to and question notices that memorialize:

• Payments for any medical services, treatment, supplies, or equipment that were not received;
• Dates of service that differ from the dates the service or item was actually received;
• Payments for ambulance transportation that was not provided; and
• Duplicate payments for the same service or item or for home medical equipment while hospitalized.

In addition, be especially cautious if a health care provider states that:

• A test or equipment is “free” but an insurance number is required;
• The more tests given, the “cheaper” they are;
• The insurance company can be convinced to pay for the services or equipment; or
• The insurance company will pay for the services or the equipment provided–if an incorrect diagnosis or inaccurate description is communicated to it.

Anything that strikes Medicare beneficiaries as unusual or troubling about any oral or written statement given in connection with medical care should prompt further inquiry or action to ensure the prevention of health care fraud.

Anyone with information concerning suspected health care fraud or irregularities should contact the HHS at 1-800-HHS-TIPS (1-800-447-8477).