Missouri Doctor Admits Defrauding Medicare, Medicaid
ST. LOUIS – A doctor from Moberly, Missouri pleaded guilty Tuesday to federal charges and admitted falsely using his father’s name to bill Medicare and Medicaid for medical services.
Dr. Justin G. LaMonda, 41, pleaded guilty in U.S. District Court in St. Louis to two counts of making false statements related to health care matters.
Dr. LaMonda admitted as part of his plea that he and his father agreed to bill Medicare and Missouri Medicaid for services performed by Dr. LaMonda as if they had actually been performed by Dr. LaMonda’s father, who was also a doctor.
The Missouri Board of Registration for the Healing Arts suspended Dr. LaMonda’s medical license for 30 days effective Aug. 10, 2017 after he was accused of engaging in sexual activity with his office manager and prescribing her controlled substances “without sufficient examination and outside of the usual course of professional practice,” the plea says.
On Dec. 20, 2018, a Medicare administrative contractor revoked his Medicare Part B privileges after determining that he submitted reimbursement claims for services performed when he was suspended. Then, on Sept. 12, 2019, the Missouri Medicaid Audit and Compliance Unit terminated his Medicare provider number.
Dr. LaMonda admitted that as early as Dec. 20, 2018, he and his father agreed to bill Medicare for services performed by Dr. LaMonda as if they had been performed by his father. After Dr. LaMonda’s Missouri Medicaid billing privileges were terminated, the pair expanded their scheme to include Medicaid claims, the plea says.
Dr. LaMonda instructed his billing personnel to use his father’s unique billing provider number on claims for payment, on referrals to other health care providers and on orders for durable medical equipment, falsely claiming that the father had performed the medical services or ordered additional equipment or treatment, the plea says.
When payments were received for services performed by Dr. LaMonda, his father would transfer the funds to Dr. LaMonda, the plea agreement says.
Dr. LaMonda admitted causing total losses of $537,322 to Medicare and Missouri Medicaid.
At sentencing, Dr. LaMonda could face up to five years in prison, a fine of $250,000 or both.
The U.S. Department of Health and Human Services Office of Inspector General, the FBI and the Missouri’s Attorney General’s Medicaid Fraud Control Unit investigated this case. Assistant U.S. Attorney Amy Sestric is prosecuting the case.