Business Partners in Crime

807
New Medicare Card ++First one rejected for Copyright Trademark issues. Please let me know what I need to remove or alter. Is it the DHHS LOGO? Card design curve? Part of number shown? You accept Social Security cards with the same logo. This was accepted in 2018. iStock # 653549364. Just let me know how to get the new card accepted… thanks!++++

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.

You can report suspected Medicare fraud by contacting the Office of Inspector General’s Medicare fraud hotline at 1-800-447-8477. This hotline is available 24 hours a day, 7 days a week.

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.

  1. 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.

 

 

SHARE
Previous articleCutting Off the Blood Supply
Next articleA Sucker for Fraud

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.