Grand Jury indicts Chesterfield psychiatrist and business partner in health care fraud and money laundering scheme
ST. LOUIS, MO – Dr. Franco Sicuro, of Chesterfield, Missouri, and Carlos Himpler, of Baton Rouge, Louisiana, were indicted on multiple charges of conspiracy and health care fraud charges. The indictment charges that as part of a fraud scheme Genotec DX and Midwest Toxicology Group, owned by Dr. Sicuro and Carlos Himpler, received over $15 million dollars for clinical laboratory tests that Genotec DX and Midwest Toxicology Group did not perform.
According to the indictment, Dr. Sicuro and Carlos Himpler falsely represented to Medicare, United Health Care, Aetna-Coventry, Anthem Blue Cross-Blue Shield, and Cigna that Genotec DX and Midwest Toxicology Group had performed quantitative urine drug tests and genetic tests, although neither laboratory had the equipment to perform the tests. To carry out the fraud scheme, Dr. Sicuro and Carlos Himpler paid other clinical laboratories about $125 to perform tests on a single urine specimen. Genotec DX and Midwest Toxicology Group then marked-up the same tests and billed insurance companies thousands of dollars for the same tests. In many instances, Genotec DX and Midwest Toxicology Group unbundled tests, which should have been billed as one test, billed the tests separately, and were paid $30,000 to $50,000 for a single urine drug test. To avoid detection, reimbursement claims were submitted on different days for the same patient and date of service but included different billing codes.
One business affected by the fraud scheme was UFCW Local #655, which paid Genotec DX $1,086,450.87 for urine drug tests for 7 union members between January and October 2015. UFCW Local #655 also paid Midwest Toxicology Group $150,596.74. Unknown to UFCW Local #655 and the public and private health care insurers, Midwest Toxicology Group was not certified by state or federal agencies to operate as a clinical laboratory and had no testing equipment.
Conspiracy to defraud carries a maximum penalty of five years imprisonment for each count and a fine of $250,000 or both. The health care fraud violations carry a maximum penalty of 10 years imprisonment for each count and a fine of $250,000 or both. Restitution to the victims is also mandatory.
The Federal Bureau of Investigation, U.S. Department of Health and Human Services, Office of the Inspector General investigated the case. Assistant United States Attorneys Dorothy McMurtry and Meredith Reiter are handling the case for the U.S. Attorney’s Office.