Federal prosecutors allege unnecessary treatments generated millions through false Medicare billing.
Nevada doctor, Stephen Dubin, of Henderson, Nevada, is facing federal charges after prosecutors accused him of taking part in a Medicare fraud scheme that allegedly brought in millions of dollars through unnecessary wound treatments for older patients. Officials said the case involved billing false claims amounting to more than $95 million. The claims involved amniotic wound grafts, products that are made from donated human tissue and are sometimes used to help certain wounds heal.
Prosecutors claim the doctor owned and operated Dubin Medical Consultants, also known as Wound MD, and frequently worked with distributors that supplied the wound grafts and accepted illegal kickbacks, bribes, and rebates in exchange for buying their products. Investigators said some of those payments were disguised through rebate agreements that made the products appear to cost more than they actually did. Medicare was then billed based on the inflated prices instead of the lower amounts that were allegedly paid. The indictment also claims another supplier sent illegal payments through a sham company and a pass-through bank account to hide the money trail.
According to court documents, patients received these grafts even when standard wound care had not been fully tried or completed, which is normally expected before Medicare covers advanced treatments, and the products were placed on infected wounds, wounds that had already failed to improve with similar treatment, and wounds that were much smaller than the amount of graft material used. Prosecutors believe product choices were based on the largest possible payment instead of what would best help the patient. When this happens, the well-being of the patient can be compromised. Court documents also accuse the doctor of changing patient records to make the treatments appear medically necessary when they weren’t. Records were altered to meet Medicare billing rules and support payment requests that otherwise may not have been approved, and the funds received by Dubin were used to support an expensive lifestyle.
The defendant has been charged with one count of conspiracy to commit health care fraud along with five counts of health care fraud. If convicted, each fraud charge carries a maximum prison sentence of 10 years. A conviction would depend on the evidence presented during the court process, and the doctor is presumed innocent unless proven guilty beyond a reasonable doubt.
The investigation is being handled by the Federal Bureau of Investigation, the Office of Inspector General for the Department of Health and Human Services, and the Defense Criminal Investigative Service. Prosecutors from the Justice Department’s Fraud Division and the U.S. Attorney’s Office for the District of Nevada are handling the case. Federal officials said this marks the first announced Nevada case handled through the National Fraud Enforcement Division since the launch of the West Coast Health Care Fraud Strike Force. That group was formed earlier this year to bring together federal prosecutors and investigators from several western states to pursue health care fraud cases involving government insurance programs.
The Department of Justice said its Health Care Fraud Strike Force program has charged more than 6,200 defendants since 2007. Prosecutors say those cases involved more than $45 billion in false billings submitted to federal health care programs and private insurance companies. Officials said they will continue working with other agencies to investigate suspected fraud and protect taxpayer-funded health care programs from abuse.
Sources:
Nevada Doctor Charged with $95M Wound Care Fraud on Medicare
Justice Dept. Charges Doctor in $95 Million Skin Substitute Fraud Scheme
Henderson Doctor Indicted In Alleged $95M Medicare Fraud Scheme
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