Steal public money by billing for unnecessary medical procedures
FRANKFORT, Ky. (April 15, 2024) — The owner and the medical director of a Kentucky pain clinic were sentenced last week for their respective roles in a scheme that defrauded Medicare, Medicaid and commercial insurance companies of over $4 million for medically unnecessary urine drug testing.
Dr. William Lawrence Siefert, 70, of Dayton, Ohio, the clinic’s medical director, was sentenced to one year and six months in prison and ordered to pay $1,968,763.10 in restitution. Dr. Timothy Ehn, 51, of Union, Kentucky, the clinic owner and a licensed chiropractor, was sentenced to two years and six months in prison and ordered to pay $3,773,569.30 in restitution.
“The defendants enriched themselves through a fraudulent urine drug testing scheme that cost Medicare, Medicaid, and commercial insurance companies over $4 million,” said Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division. “The Criminal Division is committed to protecting American taxpayers from doctors who abuse their positions to steal public money by billing for unnecessary medical procedures.”
“Through zealous collaboration with our law enforcement partners, we’re holding these defendants accountable,” said Kentucky Attorney General Russell Coleman. “I’m especially proud of Detective Supervisor Mike McGuffey and the entire Attorney General’s Medicaid Fraud and Abuse team for investigating these crimes and delivering justice.”
According to court documents and evidence presented at trial, Ehn and Siefert orchestrated a scheme in which clinic staff billed for urine drug tests that were not medically necessary but were lucratively reimbursed by taxpayer-funded insurance providers like Medicare and Medicaid. Ehn and Siefert continued in their scheme even as their expensive drug testing machine malfunctioned because it was not properly maintained, which caused the machine to produce results that falsely suggested patients were testing positive for street drugs like ecstasy or heroin. Insurance proceeds from urine drug testing ended up comprising three-quarters of the clinic’s revenue.
“These sentences are a testament to the fact that the FBI and our law enforcement partners will not stand by while licensed physicians choose to defraud federally-funded health insurance programs in order to line their own pockets,” said Special Agent in Charge Michael E. Stansbury of the FBI Louisville Field Office. “As a result of a collaborative effort across all levels of government, patients will no longer have to endure unnecessary medical tests and the taxpayer’s money will not be wasted.”
“Together with our federal, state, and local partners, DEA remains steadfast in our commitment to identify and root out health care professionals who fail to live up to their responsibilities and commitments,” said Special Agent in Charge Orville O. Greene of the Drug Enforcement Adminisration (DEA) Detroit Field Division. “These sentences should serve as a warning there is zero tolerance for fraud, no matter what form it takes.”
“Health care providers who cause the submission of Medicare and Medicaid claims for medically unnecessary services pose a significant risk to these programs and the patients who rely on them,” said Special Agent in Charge Tamala E. Miles of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “These sentences exemplify how HHS-OIG works diligently with our law enforcement partners to hold accountable individuals who, to satisfy their own greed, exploit federal health care programs.”
On March 23, 2023, a federal jury convicted Siefert of health care fraud, and Ehn of health care fraud and conspiracy to commit health care fraud.
The Kentucky Attorney General's Medicaid Fraud and Abuse Control Unit, FBI, DEA and HHS-OIG investigated the case.
Trial Attorneys Dermot Lynch and Lindsey Carson and Assistant Chief Lauren Kootman of the Criminal Division’s Fraud Section prosecuted the case.
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.
The Kentucky Attorney General’s Office of Medicaid Fraud and Abuse Control receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,650,000 for the federal fiscal year (FY) 2024. 25 percent of that grant, totaling $1,662,500 for FY 2024, is funded by the Commonwealth of Kentucky.
Lt. Gov. Crouch, IHCDA announce investment in affordable housing
IRS, Security Summit partners announce 9th annual National Tax Security Awareness Week starting Dec. 2
Kentucky to help connect patients with medical providers as part of its medical cannabis program
