Masterminds nailed for fraud schemes involving unnecessary tests

A clinic operator and a physician on opposite sides of the country were sentenced last week for seperate fraud schemes that billed government payers for unnecessary tests. A Boston physician was sentenced to 11 months and ordered to pay $9.3 million for billing Medicaid for unnecessary urine samples, and a San Diego clinic owner got 30 months for a $1 million scheme that capitalized on seniors.

Punyamurtula Kishore, M.D., owned a Brookline-based chain called Preventative Medical Associates that collected urine samples from drug treatment centers and then billed MassHealth for testing services, according to the Boston Globe. In fact, those samples were never tested and the patients were not being treated at Kishore's clinics. Kishore was arrested four years ago for the $9.3 million scheme because federal authorities thought he was preparing to leave the country.

In a town due east of San Diego,  Gevorg "George" Kupelian was sentenced to 30 months for his role in a Medicare scheme that totaled nearly $1 million, according to an FBI release. Kupelian established the El Centro Clinic and then hired a physician for the sole purpose of using his Medicare billing number to submit claims. He also paid recruiters to seek out senior citizens that were given a free pair of shoes  or a lunch buffet in exchange for undergoing a "pre-determined gauntlet of tests," none of which were necessary. (A mini version of last week's massive New York City sneaker bust.)

Additionally, the physician hired by Kupelian was frequently absent, and patients were instead seen by a physician's assistant that was not licensed to practice in California. In over 800 cases, cell phone records of the physician showed the clinic billed for tests when he was not at the facility.

In November, physicians argued over whether high-tech drug screening tests, which are potential money makers for clinics and labs, were necessary given the high cost. Earlier last year, FierceHealth Payer: Anti-Fraud reported on three Connecticut physicians that were paid for nearly 24,000 drug tests on 145 patients. Experts have said that education and outreach to help physicians understand the specific purpose of various laboratory tests will improve unnecessary lab testing.  

For more:
- here's the Boston Globe article
- read the FBI release

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