Baton Rouge Doctor and His Medical Billing Supervisor Plead Guilty to Fraudulent Billing Scheme
A Baton Rouge, Louisiana-based doctor pleaded guilty yesterday and his medical billing supervisor pleaded guilty today for their roles in a scheme to defraud Medicare and other health care insurers.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office, and Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office made the announcement.
John Eastham Clark M.D., 66, of Baton Rouge, pleaded guilty on Feb. 13 to count one of an indictment charging him with conspiracy to commit health care fraud. His sentencing has not been scheduled yet by U.S. District Judge Shelly D. Dick of the Middle District of Louisiana, who accepted his plea. Charlene Anita Severio 56, of Walker, Louisiana, pleaded guilty today to one count of an indictment charging her with conspiracy to commit health care fraud and wire fraud and two counts of the indictment charging health care fraud. Her sentencing has not been scheduled yet by Judge Dick, who accepted her plea.
“For nearly a decade, John Eastham Clark and Charlene Anita Severio submitted fraudulent claims to Medicare and other health insurers for payments they were not entitled to receive,” said Assistant Attorney General Benczkowski. “These guilty pleas should serve as a warning to unscrupulous doctors and other medical professionals: the Criminal Division’s Medicare Fraud Strike Force and our law enforcement partners will aggressively investigate and prosecute illegal billing practices and other fraudulent schemes that steal taxpayer dollars and increase healthcare program costs for all Americans.”
“In defrauding the Medicare system, Dr. Clark violated a sacred oath taken by physicians but above all he violated the law,” said U.S. Attorney Fremin. “Ms. Severio, an employee of Dr. Clark, submitted fraudulent claims to both Medicare and other health care insurers as part of the scheme. We will continue to hold medical professionals accountable for abusing positions of trust in the community and for harming the financial integrity of our health care system. I want to thank the Department of Justice’s Criminal Division, Fraud Section, the FBI, Health and Human Services - Office of Inspector General and the dedicated attorneys and staff from our office for their outstanding efforts in this case.”
“Today’s guilty pleas clearly illustrate that, along with our law enforcement partners, we will aggressively pursue criminal charges against bad actors in the Medicare program,” said HHS-OIG Special Agent in Charge Porter. “Those intent on robbing patients with legitimate medical needs of access to taxpayer funds earmarked for their health care, will ultimately pay a heavy price.”
“Agents of the Federal Bureau of Investigation remain dedicated to combating health care fraud and to doing our part in reducing the impact that opioids have on our nation,” said FBI Special Agent in Charge Porter. “This was a case that spanned multiple years and has resulted in numerous convictions. It highlights the cooperation between the FBI and the Health and Human Services - Office of the Inspector General.”
Clark was a co-owner and the medical director of Louisiana Spine & Sports LLC, a pain management clinic located in Baton Rouge. According to plea documents, the charge stems from Clark’s role in a scheme to submit fraudulent claims to Medicare and other health care insurers. Specifically, as part of his guilty plea, Clark admitted that from approximately June 2005 through March 2015, he, along with his billing supervisor Severio, and others, conspired to submit fraudulent claims indicating that minor surgical procedures occurred on days subsequent to office visits, when in fact the office visits and procedures took place on the same day. Clark admitted that this practice, commonly referred to as “unbundling,” was done to defraud health care insurers for non-reimbursable office visits. Clark further admitted to falsifying, and directing Severio and others to falsify, records substantiating the fraudulent claims.
Severio was a billing supervisor at Louisiana Spine & Sports, and worked for Clark. According to admissions made as part of her guilty plea, from approximately June 2005 through March 2015, Severio conspired with Clark to submit fraudulent claims to Medicare and other health care insurers. Specifically, Severio admitted that she knowingly and willfully submitted fraudulent claims indicating that minor surgical procedures performed by Clark occurred on days subsequent to office visits, when in fact the office visits and procedures took place on the same day. Severio admitted that this practice was done to defraud health care insurers.
In another case involving Louisiana Spine & Sports, on Nov. 20, 2018, Gray Wesley Barrow M.D., a co-owner of Louisiana Spine & Sports, pleaded guilty to a scheme to receive approximately $336,000 in illegal health care kickback payments. Barrow is scheduled to be sentenced on March 1. In addition, Christopher William Armstrong, a former physician’s assistant at Louisiana Spine & Sports, pleaded guilty on Nov. 27, 2018 for his role in a scheme to unlawfully distribute thousands of oxycodone pills. Armstrong is scheduled to be sentenced on April 16.
The case was investigated by HHS-OIG and the FBI. Assistant Chief Dustin M. Davis and Trial Attorney Justin M. Woodard of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Elizabeth E. White of the Middle District of Louisiana are prosecuting the case.
The Criminal Division’s Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.