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Chiropractors Sentenced In Health Care Fraud Scheme | Rebuild Your Back

01 Aug 2006 02:31 pm

Chiropractors Sentenced In Health Care Fraud Scheme

Two chiropractors — Eric and Christopher Topel of Atlanta, Georgia – have been sentenced in United States District Court on charges of health care fraud.

The two brothers were convicted of these charges in February, 2006 and both were sentenced on June 2nd, 2006 to 2 years, 10 months in prison followed by three years of supervised release, during which they each will be required to perform 350 hours of community service.

A very light sentence considering that they could have received as much as 10 years in prison for the offense.

According to a press release issued by the Federal Bureau of Investigation: From approximately late 2003 into 2005, at various back pain clinics within the state of Georgia, the two chiropractors engaged in insurance fraud scams that together attempted to bilk Blue Cross and Blue Shield of Georgia out of almost $2 Million.

The scheme involved false billing for a non-surgical back pain procedure known as Veterbral Axial Decompression or “VAX-D.”

Blue Cross considers VAX-D to be investigational and not medically necessary, and has made it clear to health care providers that it does not cover the procedure. However, the Topels devised a way to receive reimbursement from Blue Cross for this non-covered procedure anyway.

Their plan involved misleading Blue Cross into believing they were performing other services. Or, to but it bluntly, they lied and submitted billing for services that they did not perform… but that the insurance provider would cover.

Specifically, the Topels used an inapplicable medical billing code on their insurance claims that pertained only to surgical procedures, rather than the medical billing code for VAX-D.

The pair also went so far as to instruct their employees not to call the procedure “VAX-D” when speaking to Blue Cross representatives, and to conceal references to “VAX-D” in the patient files.

In other words, they falsified medical records.

As part of the scheme, BPI of Columbus billed Blue Cross for over $630,000, and BPI of Albany billed Blue Cross for over $860,000, all for VAX-D. During the same time period, Christopher Topel’s Atlanta-based clinics also billed Blue Cross for over $800,000 for VAX-D procedures.

Among the chiropractic clinics involved were:

  • The Back Pain Institute of Albany, Georgia (“BPI of Albany”)
  • The Back Pain Institute of Columbus, Georgia (“BPI of Columbus”)
  • As well as several other back pain clinics in the metropolitan Atlanta area.

After the sentencing, United States Attorney David E. Nahmias made the following statement:

“The Topels were health care providers who, between the two of them, cheated Blue Cross Blue Shield of Georgia out of over $2 million. By doing so, the Topels sought to enrich themselves at the expense of ordinary Americans who pay Blue Cross premiums. Those who would engage in similar schemes should take notice of the consequences of engaging in fraudulent billing practices that contribute to escalating health care costs for all.”

I believe a round of applause goes to the special agents of the FBI who investigated this case, the prosecuting attorneys (Assistant United States Attorneys Justin Anand and Teresa D. Hoyt) United States Attorney David E. Nahmias and United States District Judge William S. Duffey, Jr. for all their hard work in putting the bad guys where they belong.

http://atlanta.fbi.gov/dojpressrel/pressrel06/healthcarefraud060206.htm

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