Medicare Manicures

Physical therapist placing kinesio tape on patient's foot

On the official website for Medicare, there is a straightforward explanation as to what the government health insurance program will pay for and what it will not when it comes to foot care. It explicitly says that it doesn’t cover trimming, cutting or clipping of nails. Despite the blatant explanation, an Ocala, Florida podiatrist committed healthcare fraud by billing two government healthcare programs – Medicare and TRICARE – for a higher priced procedure, while performing routine foot care, such as nail clipping. The podiatrist illegally received more than $1.5 million from the scam.

 The podiatrist had the designation of being among the top one percent of billers nationwide for the “removal of skin and muscle,” claiming that more than half of the procedures performed in his office were for that reason. (Being a top biller for that procedure put him on the radar for suspicious billing practices.)

The podiatrist took advantage of the two government programs meant to provide seniors and military personnel and their families with healthcare to feed his foot fraud fetish. He illegally collected $1,504,952.67 between Medicare and TRICARE. (That amounts to more than 75,000 pedicures at $20 a pop.)

An investigation into the podiatrist’s billing practices found that most of the times he billed, he was actually providing routine foot care, such as clipping toenails, which is definitely not a reimbursable service. (But as you well know, the government is not in the business of paying for manicures or pedicures.) He carried out his fraudulent foot scam by using a false diagnosis code and a false billing code. He falsified his patients’ medical files to make it look like he actually was performing the services he claimed.

The 55-year-old Ocala podiatrist pleaded guilty to one count of healthcare fraud. At sentencing, he is facing up to 10 years in prison. He must also pay full restitution of more than $1.5 million for the fraudulent healthcare reimbursements. (I don’t know about you, but I would definitely not want to be in his shoes during sentencing. He may be headed to prison where no one’s feet get pampered.)

Today’s “Fraud of the Day” is based on an article entitled, Ocala doc made feds foot the bill for toenail clipping,” published by The Gainesville Sun on July 10, 2017.

Ocala podiatrist Dr. Michael Rotstein, 55, pleaded guilty on Monday to one count of healthcare fraud. Rotstein billed Medicare and TRICARE for a service that he called “removal of skin and muscle,” but which federal prosecutors said often was just “routine foot care, including the clipping of toenails.”

Rotstein faces up to 10 years in prison and must pay restitution of approximately $1.5 million. A sentencing date has not yet been set.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.