Clinic business

Doctor’s Medicare Fraud Charge Implicates Ellwood City Clinic | Local News

A Florida man is facing federal charges for allegedly submitting fraudulent health insurance claims, using an Ellwood City facility as the basis for his research.

Daniel Hurt, 58, of Fort Lauderdale, has been charged in federal court with one count of conspiracy related to fraudulent claims submissions, according to a news release by U.S. Attorney for the Western District Cindy K. Chung. Hurt is charged by criminal indictments with conspiracy to commit health care fraud, pay and receive illegal bribes and engage in money laundering, according to the report.

From late 2018 until October 2019, Hurt participated in a conspiracy related to Medicare’s billing for cancer genomic testing (CGx), the report said. The CGx test uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers. The method does not diagnose cancer.

As alleged, Hurt and his co-conspirators, including individuals associated with so-called marketing entities, acquired thousands of test samples from Medicare beneficiaries located across the United States. Traders used targeted campaigns to entice recipients to submit CGx samples through mouth swabs sent to their homes or provided to them at so-called “health fairs” around the country.

The injury would have caused CGx samples to be sent to Ellwood City Medical Center and used the facility as a billing entity for Medicare purposes, even though the facility did not have properly validated equipment to perform CGx tests on site. Facility staff were required, at Hurt’s request, to repackage the samples and send them to third-party reference labs capable of performing the tests, the document said. To justify Medicare reimbursement, Hurt and his co-conspirators obtained prescriptions from telemedicine doctors. He caused Ellwood City Medical Center to submit health insurance claims exceeding $12,000 per beneficiary.

Between January 2019 and approximately October 2019, Medicare reportedly reimbursed the facility more than $25 million for CGx testing. The information further alleges that during this period, Hurt ordered personnel at the Ellwood City facility to transfer millions of dollars from its related accounts to bank accounts controlled by Hurt. In turn, Hurt allegedly used the funds he obtained from this facility to pay millions of dollars in bribes to traders, among others, in exchange for their efforts to obtain CGx samples.

To conceal the bribes, Hurt allegedly entered into fictitious contracts with the traders. Similarly, Hurt, acting through entities he controlled, entered into similar agreements and business arrangements with the ECMC that disguised the payments he obtained from the establishment as allegedly legitimate payments, including payments related to laboratory management services at Ellwood City Medical Center, the investigation showed. In fact, payments would have been based on the volume of CGx tests and the amount of resulting Medicare reimbursements.

Reportedly, Hurt and others used a portion of Medicare reimbursements obtained through the fraudulent submission of CGx claims to conduct monetary transactions over $10,000, including about $3 million in payments for the purchase. of a luxury boat in Florida, a boat called “In My DNA”.

Injured faces a maximum penalty of five years in prison and a fine not exceeding the greater of $250,000 or an alternative fine in an amount not exceeding the greater of twice the gross pecuniary gain for any person or twice pecuniary loss to anyone other than the defendant.

Under federal sentencing guidelines, the actual sentence imposed would be based on the seriousness of the offense and the criminal history, if any, of the defendant.

The Federal Bureau of Investigation, the Office of Inspector General of the United States Department of Health and Human Services and the Internal Revenue Service – Criminal Investigation led the investigation into the defendant.

An accused is presumed innocent unless and until proven guilty or tried by a court.