AROUND THE WORLD CHIROPRACTIC
GRANITE CITY CHIROPRACTOR PLEADS GUILTY TO HEALTHCARE FRAUD AND MONEY LAUNDERING
James L. Porter, Acting United States Attorney for the Southern District of Illinois, announced today, that Bridget Brasfield, 45, of Edwardsville, Illinois, pled guilty to a two-count information charging Health Care Fraud and Money Laundering. Sentencing has been set for August 30, 2016, in U.S. District Court in Benton, Illinois. At that time Brasfield will face up to 20 years in prison, a fine of up to $500,000, and up to 3 years of supervised release.
During her plea hearing, Brasfield, who was a chiropractic physician licensed in Illinois, who practiced in Granite City, admitted that between January of2011 and January of2014, she submitted approximately $500,000 in false and fraudulent bills to various health care benefit plans. The fraudulent submissions to Medicaid, Medicare, Tricare, Federal Employees Health Benefit Program, Blue Cross Blue Shield of Illinois and Coventry Insurance claimed that a Medical Doctor had provided services to patients at her Granite City Office when in fact the Doctor was out of the country when the services were claimed to have been provided. Brasfield also admitted that she had engaged in a financial transaction that involved criminally derived proceeds from her health care fraud. The specific transaction involved $12,000 in criminally derived funds that she transferred in violation of federal money laundering statutes.
The case is being prosecuted by Assistant United States Attorneys Ranley R. Killian and Scott A. Verseman.
Source: https://www.justice.gov/
UNITED STATES AND TENNESSEE FILE SUIT AGAINST LENOIR CITY CHIROPRACTOR AND MANCHESTER PHYSICIAN
Suit Alleges Defendants Defrauded Medicare and TennCare of Over $1 Million While Operating Four Pain Clinics
The United States and Tennessee filed suit in U.S. District Court in Nashville today, alleging that Matthew Anderson, a Chiropractor from Lenoir City. Tenn,. and David Florence, a Doctor of Osteopathy from Manchester. Tenn,. made fraudulent claims to Medicare and TennCare in violation of the False Claims Act and the Tennessee Medicaid False Claims Act, announced David Rivera, U.S. Attorney for the Middle District of Tennessee. The suit also names the Cookeville Center for Pain Management; Preferred Pain Center of Grundy County; McMinnville Pain Relief Center; and PMC Management; and claims that the defendants have been unjustly enriched and caused Medicare and TennCare to pay out money through mistake of fact.
“The U.S. Attorney’s Office will work with our federal and state partners and aggressively pursue those who seek to profit at the expense of taxpayers,” said U.S. Attorney David Rivera. “It is imperative that those who profit from dispensing pain medication
always consider the well-being of patients as well as the addiction epidemic facing this country.”
Anderson is a chiropractor who operated four pain clinics in Tennessee. Although several of these clinics changed names at times, they were recently known as Cookeville Center for Pain Management; Spinal Pain Solutions in Harriman, Tenn; Preferred Pain Center of Grundy County in Gruetli Laager, Tenn; and McMinnville Pain Relief Center. Anderson operated these clinics both on his own and later through his management company, PMC Management. All of the clinics are now closed, except that the clinic in Harriman, Tenn. now operates under a new name with new owners.
According to the complaint, Anderson believed that medical clinics had to have a physician owner, so he recruited several physicians to serve as the sham owners of the four pain clinics, while Anderson, and later his company PMC, managed the clinics. In fact, according to the complaint, Anderson was the true owner who controlled the pain clinics during the entire time they were in operation.
The complaint alleges that the four pain clinics engaged in the following fraud schemes:
• Anderson operated Cookeville Center for Pain Management as a pill mill in which a nurse practitioner wrote prescriptions for controlled substances for Medicare and TennCare patients that had no legitimate medical purpose. Medicare and TennCare ultimately paid for those prescriptions, which were not allowable under Program rules.
• Anderson instructed employees at the four pain clinics to upcode office visits, by assigning an inaccurate billing code to increase Medicare reimbursement.
• Anderson continued to allow the pain clinics in Cookeville and Harriman to operate as pain management clinics and bill Medicare for services during a period in 2012 in which medical directors were not on site for the minimum time during operating hours as required by Tennessee law governing pain management clinics. As a result, according to the complaint, Medicare paid for nonreimbursable office visits, injections, and controlled substances prescriptions written by nurse practitioners at the clinics, without the required oversight of a medical director.
• In addition, David Florence, a doctor of osteopathy in Manchester, Tenn., who was one of the sham physician owners, also ran a pill mill out of his Center for Advanced Medicine in Manchester.
According to the complaint, Anderson reaped over $5 million from the four pain clinics, and took over 90% of the pain clinics’ profits, while the sham physicians only earned a salary for their service as medical directors. The government alleges that the scheme defrauded Medicare and TennCare of at least $1 million. The United States and Tennessee are seeking to recover treble damages plus penalties pursuant to the False Claims Act.
Source: https://www.justice.gov/ EB3
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