In September 2022, Chilivis Grubman attorneys discussed how Medicare revocation can create a dire situation for providers, and how some providers try to skirt the revocation restrictions. According to the U.S. Department of Justice, Dr. Kenneth Mitchell is one such provider.
Dr. Mitchell owned an on-site foot care service for adult foster home residents. His billing privileges were suspended for suspicious billing practices. Dr. Mitchell then convinced another unsuspecting provider eligible to bill Medicare to partner with him to create a new medical entity. He convinced his new partner to put her name on the business and banking documents for the new entity, according to the government’s newest press release. Dr. Mitchell worked at the clinic and billed Medicare for services he rendered, but exclusively under the name of his partner. He billed Medicare for about $1.8 million. Once law enforcement investigated, Dr. Mitchell submitted false statements to Medicare under his partner’s name to undermine the investigation, according to the government. During the investigation, the government accused Dr. Mitchell of making false statements to investigators.
Dr. Mitchell was convicted of one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, one count of falsification of records in a federal investigation, and one count of identity theft (to be served consecutive to any other sentence). On May 4, 2023, a federal judge sentenced Dr. Mitchell to seven years in prison. The DOJ’s press release does not discuss whether Dr. Mitchell’s partner knew that Dr. Mitchell was submitting claims using her credentials.
Every provider should be attentive to Medicare administrative requirements. Medicare can revoke the billing privileges of a provider for over twenty different reasons. 42 C.F.R. § 424.535. Some reasons are serious, such as felony convictions and patient harm. Other reasons may seem administrative and minor. However, the consequences of a Medicare adverse action can be dire. And fighting adverse administrative actions requires diligent and swift action. Unfortunately, many providers do not appreciate the seriousness of Medicare administrative matters nor the minimal appeal options (when available) until it is too late. For some providers, the result is a temptation to skirt the revocation restrictions. This too can have significant consequences, such as prison, as Dr. Mitchell’s case highlights.
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with white-collar criminal investigations and health care fraud investigations. If you need assistance with such a matter, please contact us today.