Lexington Man Sentenced for Role in Health Care Fraud Conspiracy
LEXINGTON, Ky. – On Monday, a Lexington man was sentenced, by Senior U.S. District Judge Joseph M. Hood, for his involvement in a health care fraud conspiracy. Samuel L. Ford, 40, was sentenced to 24 months in federal prison and 36 months of supervised release, for his role in submitting fraudulent claims for urine drug testing to insurers that administer the Kentucky Medicaid program.
Ford previously admitted to the conspiracy with Mason Routt, the owner of a toxicology laboratory in Nicholasville, Kentucky, known as C.A.L. Laboratory Services (“CAL”), and Dinesh Goyal, the owner of a separate toxicology laboratory in Owensboro, Kentucky known as Tristate Medical Laboratory (“Tristate”). CAL provided urine drug testing services for physician clients. Beginning in late 2015, health care organizations who administer the Kentucky Medicaid program placed payment restrictions on CAL’s claims seeking reimbursement for urine drug tests, due to concerns about the legitimacy of those claims. Ford acknowledged that these payment restrictions dramatically reduced CAL’s revenue.
Ford admitted that in order to evade these payment restrictions, in October 2016, he, Goyal, and Routt agreed that urine drug tests referred to and performed by CAL would be billed to the health insurance programs using Tristate’s billing information, falsely representing that the tests were performed by Tristate. In this way, CAL received reimbursements to which it was not entitled. Ford admitted in his plea agreement that these fraudulent claims caused Humana Caresource, Aetna Coventry Cares, and Anthem Blue Cross & Blue Shield Medicaid to suffer a combined loss of $1,378,449. As part of the sentence imposed today, Ford was ordered to repay that $1,378,449 as restitution, and will not be allowed to work in the medical billing field during his three years of supervised release.
Dinesh Goyal pled guilty to the same offense in July 2019, and is scheduled to be sentenced on October 15, 2019.
Robert M. Duncan, Jr., United States Attorney for the Eastern District of Kentucky; James Robert Brown, Jr., Special Agent in Charge, Federal Bureau of Investigation, Louisville Field Office; and Derrick L. Jackson, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General (HHS-OIG), Atlanta Field Office, jointly announced the sentence.
The investigation was conducted by the FBI and HHS-OIG. The United States was represented by Assistant U.S. Attorney Paul McCaffrey.