TULSA, Okla.— Robert Charles Duke and his Catoosa business, Vision and Eye Care Medical Diagnostic and Laser Center, Inc., have agreed to pay a total of $150,000 to settle allegations of submitting false Medicare and Medicaid claims to the United States and the State of Oklahoma.
The announcement was made by United States Attorney Danny C. Williams Sr. for the Northern District of Oklahoma, Attorney General Scott E. Pruitt for the State of Oklahoma, and Special Agent in Charge Mike Fields for the United States Department of Health and Human Services Office of Inspector General, Dallas Region.
“This settlement demonstrates the U.S. Attorney’s Office’s steadfast commitment to combatting health care fraud and abuse. Along with our partners we will take swift action to investigate and prosecute violators and those who abuse the system,” said U.S. Attorney Williams. “We are dedicated to protecting taxpayer money and to ensuring Medicare and Medicaid programs are available to those who need them.”
“Stopping Medicaid fraud is a priority for the Attorney General’s Office and we appreciate our federal law enforcement partners for working with us to take action against a provider who tried to abuse the system. Preventing Medicaid fraud stops misuse of taxpayer dollars but also ensures the program resources are available to help those who need it,” said Attorney General Pruitt.
“When health care providers try to boost their profits by misrepresenting the services they bill to taxpayer-funded health care programs, our agency will make sure they are held accountable for their deceptive schemes,” said SAC Fields.
A civil complaint filed on July 28, 2014, alleged that Duke, 63, of Claremore, Oklahoma, and the Catoosa business had violated the Oklahoma Medicaid False Claims Act and the common law for unjust enrichment and breach of contract.
The lawsuit alleged that, from January 2005 to July 2014, Duke received $1,343,732.36 in Medicaid and Medicare payments after submitting false and inflated patient billings. It further alleged that Duke knowingly and wrongfully coded medical service charges to Medicare. The bills submitted to Medicare did not comply with regulations such that the documentation was incomplete and insufficient according to the allegations.
During 2006 through early 2010, Duke allegedly billed Medicare in excess of 12 hours per day on 387 occasions; 124 of those occasions were in excess of 24 hours per day. In one instance, it was alleged Duke billed for 68 hours for one day.
From 2005 to 2007, Duke allegedly submitted 422 bills claiming services were provided at the doctor’s office, at a higher reimbursement rate, when in fact, the services were performed at nursing homes. In addition, from 2008 to 2010, Duke allegedly wrongfully billed Medicaid in excess of 12 hours per day on 96 occasions.
According to the settlement agreement, Duke denied liability of wrongdoing.
The U.S. Department of Health and Human Services administers the Medicare program and the Oklahoma Health Care Authority administers the Medicaid Program for eligible lower income citizens. The Medicare Program is funded by the U.S. Federal government and the Medicaid Program is funded by both the U.S. Federal government and the State of Oklahoma.
Under the False Claims Act, Duke could have been liable to the United States for civil penalties for each claim plus three times the amount of actual damages that the United States sustained as a result of the false claims.
The case was a joint investigation by the Department of Health & Human Services – Office of Investigations and the Oklahoma Attorney General’s Medicaid Fraud Control Unit; Assistant U.S. Attorney Marianne Hardcastle for the Northern District of Oklahoma and Assistant Attorney General Niki S. Batt for the State of Oklahoma handled the case.
For more information on Medicare fraud, visit the website at www.stopmedicarefraud.gov. To report Medicare Fraud, call 1(800) 447-8477.