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TX couple faces seven health care fraud charges

Government authorities recently accused a former surgeon turned business owner of running a criminal enterprise in Texas. The physician transitioned from practicing medicine within the operating room to serving as the owner of an orthopedic and spinal disorder clinic in the Fort Worth area. During his time as a business owner, government authorities state he committed multiple acts of health care fraud.

How did the business owner commit health care fraud? Investigators claim to have evidence that from 2014 through 2017 the couple filed over 100,000 false claims with federal health care programs for physical therapy and pain management services that were not medically necessary. Ultimately, the government states the couple’s claims led to the fraudulent payment of over $5 million.

Authorities also claim the couple set their home on fire when attempting to burn evidence of the fraudulent claims. According to the prosecution, one of the parties set a fire in an outdoor fire pit with the intention of burning clinic records. The couple left the fire unattended, and it spread and burned down the residence. Upon investigation, the responding emergency fire crew found burned documents that were still legible medical records in the outdoor fireplace.  

How did these claims start and what are the potential consequences? The charges are the result of a whistleblower claim. Both have pleaded not guilty to the allegations. The charges are serious, and the government has used negative language within the indictment, calling the accused a bottom feeder and claiming he used opioids to ensure patients returned for services.

If the claims are substantiated, the accused could face substantial financial penalties as well as potential imprisonment. Negotiations will likely continue throughout the process and the couple may chose to accept a plea deal. Regardless, the allegations will likely result in the loss of the physician’s medical license, making it difficult to return to his chosen profession. These harsh penalties highlight the need to aggressively defend against these types of allegations. They can lead to more than just a slap on the wrist and a fine, they can end a career.

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