Doctor Who Falsely Diagnosed Hundreds Of Patients As Part of a Medicare Fraud Scheme Pleads Guilty
Last month, Dr. Isaac Kojo Anakwah Thompson pled guilty to one count of health care fraud. The announcement was made by the US Attorney for the Southern District of Florida and the Federal Bureau of Investigation (FBI) in conjunction with several other agencies. “The Medicare system relies on our nation’s doctors to diagnose and treat our Medicare beneficiaries,” stated U.S. Attorney Ferrer. “When doctors intentionally misdiagnose their patients for personal gain, they betray the trust of the Medicare system and the patients themselves. This case demonstrates our commitment to the investigation and prosecution of Medicare fraud, in all its varieties and against all groups of offenders.”
According to court records, Dr. Thompson engaged in a scheme to defraud Medicare’s Advantage program. The program allows beneficiaries to enroll in plans sponsored by private insurance companies. For each beneficiary who chooses to enroll in a Medicare Advantage plan, Medicare pays the sponsoring insurance company a fixed or monthly fee. Medicare adjusts the fee based on the beneficiary’s medical conditions. For the most part, Medicare determines a beneficiary’s medical conditions using diagnoses submitted by the beneficiary’s Medicare Advantage plan physician.
Between 2006 and 2010, Dr. Thompson defrauded Medicare by diagnosing 387 Medicare Advantage beneficiaries with ankylosing spondylitis, a rare chronic inflammatory disease of the spine. Dr. Thompson reported these diagnoses to Humana, which in turn reported them to Medicare. As a result, Medicare paid approximately $2.1 million in excess capitation fees, approximately 80% of which went to the defendant. Nearly all of the diagnoses were false therefore the defendant did not have a corresponding increase in his cost to treat the patients. “When physicians cheat Medicare by misrepresenting the medical conditions of their patients, our agents will work with our law enforcement partners to hold these individuals accountable for their deceptive schemes,” said Special Agent-in-Charge Shimon R. Richmond, HHS Office of Inspector General.
Richmond – along with Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Assistant Attorney General William J. Baer, George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office all participated in the investigation and prosecution of this case. Medicare fraud cases have been a high priority of the Obama administration since 2009. Often cases of this kind involve the Federal Whistleblower Act which grants whistleblowers a certain share in any award granted to the government. If you have information concerning Medicare fraud then you should inform state and federal officials and consult with an attorney who is familiar with whistleblower law and who knows how to handle qui tam law suits.