Doctor Roger D. Beyer recently pleaded guilty to conspiracy to commit healthcare fraud in the United States District Court for the Western District of Michigan. In a complaint filed on May 8, 2020, the US Attorney assigned to the case set out several allegations.
Regarding healthcare fraud, the complaint alleged that Dr. Beyer’s office improperly coded procedures reported to Medicare. The complaint alleged that Dr. Beyer directed his staff to perform a rectal diagnostic procedure repeatedly, beyond the initial diagnostic purpose of the procedure. Dr. Beyer’s offices then continuously billed Medicare for the diagnostic service even though they weren’t medically necessary. By continuously performing the diagnostic service, Dr. Beyer’s office could bill Medicare each time for that service even though it wasn’t medically necessary.
What are CPT codes?
CPT stands for Current Procedural Terminology. The American Medical Association developed CPT codes and the Health Care Common Procedure Coding System (HCPCS) to provide healthcare providers, insurance providers, and government programs a uniform system for describing medical services and billing for those services.
In Dr. Beyer’s case, the government alleged that he directed other practitioners in his two practices to bill Medicare for the diagnostic service so that Medicare wouldn’t be alarmed with so many codes for the same service for the same patient. This allowed Dr. Beyer’s office to slip past Medicare for years.
Why was this case in Federal court when the alleged incidents took place only in Michigan?
Federal courts can hear cases involving federal law and cases that affect interstate commerce. Medicare is a federal program. The US Attorney’s office frequently becomes interested in prosecuting Medicare billing fraud cases. The stakes become much higher in federal court. Often, jail time and fines are higher under federal law.
What does “conspiracy” mean?
A conspiracy occurs when two or more people act together to commit a crime. In a conspiracy, according to 18 USC 1349, anyone who conspires to commit the illegal act can be subject to the same penalties as the person who commits the illegal act. Co-conspirators can also be held liable for illegal acts in the conspiracy that took place before the person joined the conspiracy.
To be convicted of conspiracy to commit healthcare fraud, the government must prove that the defendant knowingly and willfully participated in the fraud or conspiracy to commit fraud.
What are the penalties for federal health care fraud?
Under 18 USC 1347, the penalties for health care fraud include up to 10 years in prison, up to three years of supervised release (parole), and a fine of up to $250,000 or twice the gross gain or loss from the crime, whichever is greater. Doctors can also be prohibited from participation in government programs, like Medicare, because of conviction.
What should I do if I’m being investigated for healthcare fraud?
If you’ve been contacted by federal or state law enforcement about possible healthcare fraud, it’s crucial you retain qualified counsel before making any statements to those officials. It’s important your attorney has experience in healthcare fraud cases because the subject matter, medical terminology, medical procedures, and the law governing these things can be confusing even for the most experienced practitioner.
The Barone Defense Firm is not a general practice firm. For over 30 years, the Barone Defense Firm has helped doctors and healthcare professionals through criminal charges including healthcare fraud. Our team includes a former US Attorney and attorneys licensed to practice in federal courts. We can help. Have one of the Health Care and Insurance Fraud lawyers at the Barone Defense Firm review your case today.