ST. LOUIS – A psychiatrist from Chesterfield, Missouri on Tuesday pleaded guilty in front of U.S. District Judge Sarah E. Pitlyk to a felony conspiracy charge and admitted that Medicare, Medicaid and other insurers lost more than $3.8 million based on fraudulent reimbursement claims submitted by clinical laboratories that he owned.
Dr. Franco Sicuro, 67, has also agreed to forfeit $3.1 million from various sources.
Sicuro ran, owned, served as the medical director of or was associated with health care businesses including Millennium Psychiatric Associates LLC (MPA), Advanced Geriatric Management (AGM), Centrec Care, Sleep Consultants of St. Louis LLC, Midwest Toxicology Group, Genotec Dx and Benemed Diagnostics LLC.
In 2014, AGM was certified under the Clinical Laboratory Improvement Amendments (CLIA) and was then allowed to perform quantitative lab testing. That same year, Sicuro and Carlos Himpler opened another lab, Genotec, that was in the same building as AGM but would bill insurance companies as a separate, “out-of-network” lab. To obtain CLIA certification for Genotec, Himpler and AGM staff falsely stated that AGM and Genotec operated as separate labs, although AGM and Genotec shared one part-time employee, the same medical director and the same testing equipment, Sicuro’s plea agreement says. Without the CLIA certification, Genotec could not perform any clinical lab testing.
Sicuro also admitted in his plea that he chose to remain “deliberately ignorant” of the fact that his financial interest in Genotec was concealed from private health care insurers, Medicare, and Medicaid. As a result, the insurers did not know that Sicuro and employees of AGM were referring patients for urine tests to a lab in which Sicuro had a financial interest.
Sicuro also admitted that he and other health care providers at AGM, MPA, Sleep Consultants and Rest Easy of St. Louis LLC, a company run by Himpler, ordered clinical lab tests, including urine toxicology tests, that AGM and Genotec then sent to outside “reference” laboratories for more sophisticated testing that would show the quantities of drugs instead of simply detecting their presence, as AGM’s lab equipment did.
AGM or Genotec paid the reference labs about $125 for a test and then billed insurers significantly more but did not disclose to the insurers that neither AGM nor Genotec had actually performed the tests. Medicare, Medicaid and many private insurers would not have paid the “pass-through billing” claims had they known about it, Sicuro’s plea says.
In 2015, Sicuro and Himpler incorporated Midwest, which they held out as a clinical testing lab although it did not have equipment, staff or supplies necessary to perform tests. Further Midwest was not certified by CLIA or authorized to perform tests of human specimens. Sicuro admitted that he and Himpler knew Midwest was a lab in name only but caused Midwest to bill for clinical lab tests. Sicuro further admitted that he either knew or was willfully blind to the fact that Himpler used Genotec’s CLIA certification number on reimbursement claims submitted by Midwest, deceiving health insurers into believing that Midwest performed the tests. Genotec and Midwest also frequently “split-billed;” each submitted a claim for the testing of the same specimen obtained from the same person on the same day of service.
Sicuro is scheduled to be sentenced February 8. He faces a penalty of up to five years in prison and will be ordered to repay the money.
“Providers engaging in fraudulent schemes not only compromise the integrity of essential federal health care programs but also waste valuable taxpayer dollars,” said Special Agent in Charge Curt L. Muller with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). "Alongside fellow law enforcement agencies, HHS-OIG holds accountable bad actors who exploit these programs for personal gain."
The case is pending against Himpler, 51, of the Baton Rouge, Louisiana area. He has pleaded not guilty to charges of conspiracy, health care fraud and money laundering.
The case was investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General and the IRS. Assistant U.S. Attorneys Dorothy McMurtry, Amy Sestric and Kyle Bateman are prosecuting the case.