Do you remember those Holiday Inn Express commercials? My favorite is the one where a man dressed like a doctor is performing surgery in a hospital operating room. At the end of the surgery he takes off his mask and a nurse quickly realizes he is not a doctor. As the man walks out of the OR, he admits that he is not a doctor but stayed at a Holiday Inn Express last night.
A Houston area chiropractor has been charged with collecting over $3.9 million from Medicare and TRICARE. Dr. Suhyun An claimed she was implanting neurostimulator electrodes. Prosecutors say that she was instead using inexpensive acupuncture needles. She and her staff claimed they watched YouTube videos to learn the procedure.
Prosecutors say that instead of actually performing the surgical procedure with real implants, Dr. An heard of a money making scheme that involved buying cheap devices for a few hundred dollars each (an inflated price justified only by the devices’ reimbursement potential), taping them to patients’ ears, submitting a $10,000 claim to Medicare for each service, and receiving between $6,000 and $8,000 in reimbursement for each bogus claim.
The only proper way to collect is to actually perform a special surgical procedure. Taping needles behind a patient’s ear and connecting them to a Duracell 9 volt battery doesn’t count! The services she was performing aren’t even covered by Medicare.
Is Dr. An an innocent victim who simply made a mistake? Hardly. The feds say she made a “test” claim and after she was paid, “she wrote in an email that, while she could make a lot of money billing p-stim devices, she wanted to utilize a goldilocks approach—billing enough to make significant money but not overdoing it so that she could ‘fly under the audit radar.’”
If that isn’t enough evidence of fraud, the feds also say,
“An was warned by her staff, her billing company, and even her then-husband who worked at the clinic that p-stim devices were not billable as implantable neurostimulators and that she was likely committing fraud. She was even pointed directly to the guidance of a Medicare contractor stating that these devices were not payable. Nevertheless, she continued billing—sometimes for as many as 11 devices per patient.”
When her billing company warned her that her bills seemed fishy, Dr. An emailed a consultant to see how much he would charge to make her records audit proof.
Even her husband, another chiropractor, warned her. In an email he said, “I know you don’t like problems but if this is correct, we are dispensing a device not Medicare approved, billing under an incorrect [billing code] backed by false medical documentation. So at worse we should not dispense this product to Medicare patients.”
An wouldn’t even listen to her own husband. Prosecutors say that An made it clear that she did not want to change anything about her practices or inform Medicare. She forwarded Ybarra’s message to her office manager and wrote that “I hope this mo fo didn’t send or do anything” and that “I feel like killing him right now.”
Like so many other Medicare fraudsters, the feds say Dr. An used the money to fund a lavish lifestyle; luxury cars and a million dollar home. Unfortunately for us, Medicare and TRICARE are funded with tax dollars. For just a couple minutes work, An was making thousands of dollars. Money for a service not even recognized by Medicare at the time.
Patient Complaints Lead to Medicare Fraud Complaint
Suhyan An may have thought her “Goldilocks” approach would keep her “under the audit radar” but several astute patients were appalled when they received explanation of benefits (EOB) forms showing thousands of dollars in charges to the Medicare program. Some of those patients even contacted Medicare to report An’s fraud.
False Claims Act and Whistleblower Rewards
An is being prosecuted under the federal False Claims Act, an 1863 law that allows the government to collect triple damages and high fines. The $3.9 million collected by An could result in her having to pay the government $11,700,000.00 plus penalties.
We like the False Claims Act because the law also allows whistleblowers to receive between 15% and 30% of whatever the government collects from the wrongdoer. In this case, that could be millions of dollars.
To qualify for a reward, one must have inside information about fraud involving government funded Medicare, Medicaid or TRICARE. Approximately 30 states and the District of Columbia have their own rewards program for the state funded portion of Medicaid. That means two rewards are possible in many states.
Obtaining a reward means filing a sealed complaint in federal court. Our experienced team of whistleblower lawyers handle the investigation, filing the complaint and even prosecuting the case on behalf of the government (Justice Department or state attorney general) fails to do so.
The federal government pays hundreds of millions of dollars in rewards each year. But they can only do so when concerned citizens step forward and report fraud. Medicare fraud isn’t a victimless crime. It costs taxpayers billions of dollars each year.
We accept cases nationwide. All inquiries protected by the attorney client privilege and kept strictly confidential.
Now for some fun… Holiday Inn Express “Surgeon” commercial courtesy of YouTube!