The owner of a Baton Rouge-based pain management clinic accused of bilking the Medicare program and private insurers for more than $4.4 million was among hundreds of people indicted nationwide in a federal crackdown on health care fraud, federal prosecutors said Thursday.
Dr. John Eastham Clark, 65, owner of Louisiana Spine & Sports, and Charlene Anita Severio, 54, the clinic's billing supervisor, have been accused of submitting false claims to Medicare and insurers for minor surgical procedures and for medically unnecessary urinalysis tests, prosecutors in the U.S. Attorney's Office in Baton Rouge said.
A federal grand jury indictment issued July 6 and unsealed Monday says the scheme by Clark and Severio went on for nearly 10 years, from June 2005 to March 2015. That same month, federal agents searched Clark's clinic off Bluebonnet Boulevard, WBRZ reported.
The U.S. Department of Justice announced Thursday that federal prosecutors in 41 jurisdictions nationwide have charged more than 400 people with taking part in health care fraud and opioid scams that totaled $1.3 billion in false billing.
Clark, who is from Baton Rouge, and Severio, who is from Walker, have been charged with two counts each of conspiracy to commit wire fraud and health care fraud, prosecutors said. Clark also had two additional counts of health care fraud. Their initial appearance before U.S. Magistrate Judge Richard L. Bourgeois Jr. is scheduled 9 a.m. Aug. 15.
Announced Thursday as grand jury indictments were unsealed against Clark, Severio and others, the crackdown's disclosure also revealed that one of Louisiana's top private insurers fell victim to other alleged frauds.
Prosecutors said Express ACA, a health care brokerage company based in Florida, submitted false health insurance applications for plans available under the Affordable Care Act's health exchanges to cash in on more than $500,000 in federal subsidies meant for low-income people. Among the insurers victimized by the scheme was Blue Cross Blue Shield of Louisiana, one of three companies that offer plans on Louisiana's health exchange.
Express ACA's owner, Keaton L. Copeland, and the company insurance agent, Dorothy V. Delima, submitted false applications for bronze plans that met the ACA's minimum essential coverage requirements and pocketed the full federal subsidy for those plans without the named applicants' consent, a federal indictment alleges.
Though both suspects and the company are in Florida, a federal grand jury in Baton Rouge handed up the indictment against Copeland and Delima in early July.
In the indictment over the Baton Rouge pain management clinic, Clark and Severio are accused of falsely telling Medicare and Blue Cross Blue Shield that minor procedures happened the day after an office visit so the clinic could be reimbursed for both the office visit and the procedure, resulting in $515,880 in fraudulent claims over a 10-year period.
In 2013, the spine clinic had plans to open a urinary testing lab and began storing patients' urine specimens so the lab could start doing medically unnecessary testing once the lab went on line, the indictment alleges. The urinalysis scheme, which went on from October 2013 to March 2015, resulted in $3.9 million in fraudulent claims, according to the indictment.
John McLindon, defense attorney for Clark, said Thursday he has been working with his client on the case for 18 months and several experts have looked at evidence and say what the spine clinic did was "very defensible." A trial jury will get to see that, unlike the grand jury.
"I'm very confident that Dr. Clark and all the defendants will be acquitted on this," McLindon said.
Attempts to reach Severio were unsuccessful Thursday. She did not have a lawyer identified in online court records.
In the scheme alleged against Express ACA, prosecutors charge the insurance applications were bogus for at least one of three reasons: they were filed without the applicants' knowledge, with false personal information and contact information, or with bogus income amounts for the applicants.
Copeland, 32, of Miramar, Florida, and Delima, 45, of Davie, Florida, are accused of fraudulently submitting 1,292 bronze plan applications to Blue Cross Blue Shield between the end of January 2015 and beginning of March in 2015.
In 2014 and 2015, Copeland and Delima also filed bogus applications with insurers Humana and Anthem, using the names of dead people, addresses for abandoned car lots and rental businesses, or stolen identities, the indictment says.
To further all the schemes, Copeland and Delima instructed data entry clerks to create false email addresses and passwords so they could submit insurance applications without alerting people named on the applications, the indictment says.
Copeland and Delima have been charged with multiple counts of wire fraud and conspiracy to commit wire fraud. Copeland has also been charged with identity theft.