The role of a psychiatrist is to diagnose and help treat mental disorders, often through the usage of prescription medication. Unfortunately, there are some bad apples who misuse their access to controlled substances to defraud patients and the healthcare system.
A psychiatrist and his business partner have been indicted for their roles in an extensive healthcare fraud. Dr. Franco Sicuro of Chesterfield, Mo. and Carlos Himpler of Baton Rouge, La. were both indicted on conspiracy and healthcare fraud charges.
Sicuro and Himpler co-owned Genotec DX and Midwest Toxicology Group. Apparently, they fraudulently received more than $15 million in reimbursements from Medicare and private insurance companies for clinical laboratory tests they did not perform. (Fraudsters never seem to think that insurance companies will do their due diligence and verify the billings.)
The pair allegedly billed Medicare, United Health Care, Aetna-Coventry, Anthem Blue Cross-Blue Shield, and Cigna for services that were never rendered. They billed the insurance groups stating that their labs had performed quantitative urine drug tests and genetic tests. (Maybe if these two had invested more time and money into buying lab equipment for their business, they wouldn’t be in their current predicament.)
Neither Genotec DX or Midwest Toxicology Group had the technology or equipment to perform the tests they claimed. Rather, the pair paid other laboratories to perform tests. Sicuro and Himpler would bill Medicare and private insurance companies thousands of dollars for a test that cost them $125. They would also bill for multiple individual tests, which should have been bundled together, so that they could charge anywhere from $30,000 to $50,000 for each urine drug test.
For example, Genotec DX and Midwest Toxicology Group submitted reimbursement claims for a patient on different days, including different billings codes. This was done to avoid being caught charging for individual tests rather than bundling them together. (Spoiler alert: their ‘genius’ plan didn’t work.)
If convicted, the fraudsters face a maximum of five years imprisonment for each count of conspiracy to defraud and a fine of $250,000. They also face a maximum of 10 years in federal prison for each count of healthcare fraud as well as a $250,000 fine. If found guilty, both Sircuo and Himpler will also be expected to pay restitution to Medicare and the private insurance companies.
Today’s Fraud of the Day comes from an article, “Chesterfield psychiatrist, business partner indicted in health care fraud and money laundering scheme,” published by KSDK-TV on September 24, 2020.
- LOUIS — A Chesterfield psychiatrist and his business partner were indicted for their roles in a health care fraud and money laundering scheme.
Dr. Franco Sicuro, of Chesterfield and Carlos Himpler, of Baton Rouge, Louisiana were indicted on multiple charges of conspiracy and health care fraud charges, according to the U.S. Attorney’s Office of Eastern Missouri.