Five Louisiana residents and one South Carolina man have been accused in health care fraud and kickback schemes designed to cash in on bogus testing, medical equipment prescriptions and mental health billings worth nearly $250 million to federal health insurance programs for the poor and elderly.
Among the schemes is Louisiana's piece of one of the largest health care frauds ever uncovered in the United States, totaling more than $2.1 billion nationally, state and federal prosecutors said.
Also, a St. Gabriel federally qualified health center has been accused of falsely diagnosing Iberville Parish public school students with mental health disorders that cost the state Medicaid program $1.8 million between 2011 and 2015, prosecutors added.
The nonprofit St. Gabriel Health Clinic Inc. has contracted with the Iberville Parish School Board since 1997 to provide medical services within the school system, and two of its top executives have been charged with fraud counts, prosecutors said.
According to an indictment, clinic officials never informed parents about the bogus mental health diagnoses, though they could remain on students' records for years.
U.S. Attorney Brandon Fremin and Louisiana Attorney General Jeff Landry announced the charges against the six defendants accused of defrauding the Medicare or Medicaid programs as they marked the 10th anniversary of the Baton Rouge-based Medicare Fraud Strike Force for South Louisiana.
The task force combines state and federal agencies and has charged more than 100 people since its creation with a conviction rate of almost 97%, Fremin said.
He added the rate is nearly 10% higher than the national average and is a testament to the work of state Attorney General's Office and federal prosecutors, FBI and U.S. Department of Health and Hospitals Office of Inspector General agents, and countless others who work in the health care fraud unit.
"The point here, simply put, is that partnerships are key. We've spent the last 10 years creating those partnerships, 10 years and beyond creating those partnerships, and it's paid dividends for the strike force and the state of Louisiana," Fremin said during a news conference at the federal courthouse in Baton Rouge.
"The saddest thing about this type of fraud," Landry added later, "is that it takes away from the most needy."
The most lucrative of the alleged schemes prosecutors described Tuesday centered around what they called Acadian Diagnostic Laboratories' solicitation of medically unnecessary cancer genetic tests.
Acadian Diagnostic, a Baton Rouge firm that offers toxicology, blood and genetic testing, and other labs billed Medicare for more than $240 million for the tests.
A grand jury indicted Kevin Bernard Hanley, 42, of Prairieville, who is Acadian's chief financial officer, with one count of conspiracy of defraud the United States and to pay and receive health care kickbacks and two counts of offering and paying kickbacks and bribes in connection with a federal health care program.
Prosecutors claimed Hanley and one of his co-conspirators, Mark Thomas Allen of Greer, South Carolina, had genetic tests approved by telemedicine doctors who did not treat patients but submitted claims through diagnostic testing labs that paid kickbacks for the referrals.
Allen, 51, owned Archer Diagnostics, a South Carolina company that markets medical testing, and JL Management Services, a Wyoming company that purported to perform management and billing services, prosecutors said.
Allen has been charged with one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, one count of conspiracy of defraud the United States and to pay and receive health care kickbacks, and two counts of solicitation and receipt of kickbacks and bribes in connection with a federal health care program.
Fremin said the alleged fraud involving Allen and Hanley was part of broader scheme involving 35 defendants in several states and totaling more than $2.1 billion.
In another case, the St. Gabriel Health Clinic provided medical services to Medicaid recipients and, under the Iberville Parish school contract, offered primary care and the diagnosis and treatment of mental illnesses, the indictment says.
Through the years, the contract included services for East Iberville high and elementary schools and East Iberville Math, Science and Arts Academy.
Clinic officials Victor Clark Kirk, 70, and Marilyn Brown Antwine, 51, both of Baton Rouge, are accused of falsely billing Medicaid for character development and other educational programs conducted during regular class periods. The clinic falsely portrayed the programs as "group psychotherapy," including the "Character Counts!" program, so they could seek federal reimbursement.
To further the scheme, the clinic operators falsely diagnosed the Iberville students with "Axis I" mental health disorders, a broad category that includes depression, eating and anxiety disorders, and psychotic disorders.
Prosecutors alleged in the indictment that the clinic had parents sign consent forms at the beginning of the school year for various medical services without having to provide further notification all year. The bogus diagnoses began after 2012 when Medicaid refused to further reimburse the clinic educational programs.
Kirk, the clinic's chief executive officer, and Antwine, chief operating officer, were each charged with one count of conspiracy to commit health care fraud and five counts of health care fraud. Another clinic officer already pleaded guilty to his role in the scheme in March.
With the charges pending, Fremin said he could not say how many students received the false mental health diagnoses or if the diagnoses affected the students' education.
Iberville Parish School Superintendent Arthur Joffrion Jr. did not immediately return a call for comment Tuesday.
Fremin said Kirk and Antwine were caught in an expansive U.S. Department of Justice investigation across the Gulf Coast involving 11 defendants in four U.S. Attorney's Office districts.
Dr. J. Foster Chapman, 40, of Alexandria, was also caught in the same sweep. He worked for purported telemedicine companies and wrote medically unnecessary equipment orders, like knee braces, for Medicare beneficiaries totaling $4.8 million, prosecutors said.
Chapman wrote the orders without speaking to the beneficiaries or having any doctor-patient relationship. He has been charged with one count of conspiracy to commit health care fraud and four counts of health care fraud, prosecutors said.
In a separate case, Casonya Williams, 45, a Hammond social worker, has been accused of submitting false claims for behavior health services totaling $176,000 and faces one count of health care fraud.