ANOTHER FOOT DOC PLEADS GUILTY TO FRAUD (Orthopedics This Week)
What is it about foot doctors and healthcare fraud?
For the third time in the last couple of years, a podiatrist has pled guilty to defrauding Medicare and other payers.
First it was Virginia podiatrist Ilene Terrell, D.P.M., who was sentenced to five months in prison in 2014 for lying to a grand jury about falsifying patient medical records and prescribing an Orthofix, Inc. bone growth stimulator where the claim would not have met Medicare’s guidelines
Then it was California podiatrist, Neil Van Dyck, D.P.M. who was sentenced this past April to three years in prison and a $10,000 fine for committing healthcare fraud. Van Dyck submitted over $2.8 million in fraudulent claims for reimbursement to Medicare, Medi-Cal, Tricare and private insurers. He falsely claimed that he performed more expensive procedures than he actually performed.
Now its Pennsylvania podiatrist Stephen Monaco, D.P.M., who pled guilty on August 23, 2016 for $5 million in fraudulent billings to Medicare, Medicaid and four private insurance companies. Monaco admitted that he had committed the fraud using his practice, A Foot Above Podiatry, Inc., located in Havertown, Pennsylvania.
Between January 2008 and October 31, 2014, according to the government, Monaco submitted fraudulent claims for podiatric procedures that were not provided, and podiatric procedures that were not performed, including injections, debridement (removal of dead, infected or foreign material to promote wound healing) and nail avulsions (removal of the entire or partial nail plate).
Monaco faces up to 10 years in jail. Sentencing is scheduled for November.
We are not aware of any official speculation as to why some foot doctors have been prone to committing fraud. But it’s worth noting that all three of these podiatrists were owners of small independent medical practices where internal oversight of billing practices is different from large healthcare systems. To be fair, large systems have signed plenty of settlement agreements over the past few years with the U.S. Department of Justice over alleged fraudulent billing practices.