Oregon Attorney General Hardy Myers and Oregon United States Attorney Karin Immergut today announced the conviction of William A. Bennett, on two federal felony counts of Making a False Statement Relating to Health Care Matters. This statute makes it illegal for someone to knowingly and willfully make or use a materially false, fictitious or fraudulent writing or document in connection with the delivery of, or payment for, health care services.
The charges were originally filed in February 2005, and alleged that Bennett, a podiatrist practicing in North Bend, falsified medical records and claim forms to obtain Medicaid/Medicare reimbursement for providing debridement services to patients, when all he did was clip their toenails. According to the Government's charges, debridement is a recognized surgical procedure to remove excess material from a medically diseased nail, and Medicare only pays for debridement services when patients have medically qualifying conditions. Medicare does not pay for toenail clipping; Medicaid will pay a podiatrist for providing toenail clipping, but at a lesser payment rate then debridement.
The case was tried on submission of Stipulated Facts to United States District Judge Robert Jones. According to the Stipulated Facts, a Medicare review of Bennett's billings for debridement raised questions and resulted in the commencement of a coordinated law enforcement investigation, using volunteer retired law enforcement officers posing as patients. The retired officers were provided Medicare and Medicaid cards, and called Bennett's office to schedule appointments for routine toenail clipping; the visits were recorded. During those visits, the officers' nails were clipped by Bennett, but Bennett recorded in his medical records that these patients had certain medical conditions that they did not have, and that he provided the patients with debridement services (not toenail clipping). The debridement services were then billed to Medicare and Medicaid. According to the Government, the falsified medical records were intended to protect Bennett in the event of a Medicare/Medicaid review, as the records provided medical justification for his billings.
Judge Jones found Bennett guilty on both counts, and sentenced him to three years probation and to pay a fine of $1500. The conviction also subjects Bennett to a minimum of five years exclusion as a Medicaid/Medicare provider. Bennett also entered into a separate civil/administrative settlement with the Oregon United States Attorney's Office and the United States Department of Health and Human Services, Office of the Inspector General.
The case was jointly investigated by agents from the Federal Bureau of Investigation, Office of Inspector General for the U.S. Department of Health and Human Services, the Oregon Department of Justice Medicaid Fraud Unit (MFU), and the Oregon United States Attorney's Office. The case was prosecuted by the Oregon United States Attorney's Office by Ellyn Sternfield, the Attorney in Charge of the Oregon MFU, who is cross-designated to prosecute health care cases with the United States Attorney's Office.
Ellyn Sternfield, Atty in Charge, Oregon DOJ Medicaid Fraud Unit, (503) 229-5725 x241
Bob Nesler, Assistant US Attorney, Oregon US Attorney's Office, (503) 272-1000