A 61-year-old anesthesiologist was sentenced on August 10, 2020 to 66 months in federal prison for his part in a $200 million health care fraud scheme, after pleading guilty to his involvement in the scheme involving the Forest Park Medical Center, a physician-owned hospital for bariatric and spinal surgery patients, that began operations in 2008.
The anesthesiologist admitted to one count of conspiracy to pay health care bribes and kickbacks and one count of illegal remuneration under the Travel Act. Most of the kickbacks that totaled more than $40 million were disguised as consulting fees or “marketing money,” doled as a percentage of surgeries each doctor referred to Forest Park Medical Center. The anesthesiologist is presently serving a 41-month federal prison sentence for a separate health care fraud conviction and his new sentence will be served concurrently. He was also ordered to pay more than $82.9 million in restitution.
The government had alleged that the anesthesiologist, the manager of Forest Park Medical Center, and others conspired to steer lucrative patients – particularly those with high-reimbursing, out-of-network private insurance – to the now defunct hospital by paying surgeons for referrals. Furthermore, instead of billing patients for out-of-network co-payments, instituted by insurers to de-incentivize the high costs associated with out-of-network treatment, the hospital allegedly waived co-insurance and assured patients they would pay in-network prices. Because the conspirators knew that health insurers would not accept such practices, they allegedly concealed the patient discounts and wrote off the difference as uncollected “bad debt.” The anesthesiologist was one of 18 convicted with regard to the health care fraud scheme.
The case was investigated by the U.S. Office of Personnel Management Office of Inspector General, the Federal Bureau of Investigation, the U.S. Department of Labor Office of Inspector General, the U.S. Department of Labor Employee Benefits Security Administration, the U.S. Department of Defense – Defense Criminal Investigative Service, and Internal Revenue Service Criminal Investigation, with assistance from the Food and Drug Administration Office of Criminal Investigations.
On March 17, 2017, the same anesthesiologist pleaded guilty to one count of conspiracy to pay health care bribes and kickbacks and one count of offering or paying illegal remuneration and aiding and abetting under the Travel Act. That earlier criminal case also involved Forest Park Medical Center (“FPMC”). The government alleged, in part, that the anesthesiologist and his co-defendants “knew that FPMC would pay surgeons marketing checks in exchange for bringing surgeries, especially lucrative out-of-network surgeries, to FPMC as opposed to other facilities. [A co-defendant] discussed the details of the payments with each doctor, and he kept tabs on how many surgeries they brought to FPMC. [The co-defendant] used a metric to calculate the payments based on the surgeons anticipated case volumes at FPMC. The payments quickly grew from $300,000 a month to $1.2 million a month. [The co-defendant] would update [the anesthesiologist and another co-defendant] on the bribe payments.”
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