Wednesday, July 24, 2024
73.0°F

Whitefish physician charged in multi-million-dollar Medicare billing fraud case

by BLAIR MILLER Daily Montanan
| June 26, 2024 8:35 AM

A Whitefish physician was charged Monday by the U.S. Attorney’s Office for Montana with conspiracy to commit wire fraud for allegedly helping facilitate about $39 million in fraudulent billing of Medicare and other federal benefits programs during the Covid-19 pandemic.

Ronald David Dean entered into a plea deal with federal prosecutors in which he agreed to help the government continue its investigation into the fraud, according to federal court documents, and as part of the agreement will have to pay back around $780,500 in restitution to the Medicare program and two other federal programs.

According to a criminal charging document filed Monday in U.S. District Court in Missoula by the U.S. Attorney’s Office, Dean would sign prescriptions and other documents for medical devices and Covid-19 tests for people who did not need them. In turn, two unnamed people running different telemedicine companies incorporated in Florida then billed the federal government for the costs. Dean would then receive payments as part of a kickback scheme, according to the documents.

The charging document says the entire conspiracy resulted in Dean and the two others billing Medicare, the Civilian Health and Medical Program of the Department of Veterans Affairs, and the Railroad Retirement Board $39.6 million in fraudulent claims, of which the three programs paid out at least $18 million.

In order to receive reimbursement through Medicare for durable medical equipment – things like prosthetics, braces and orthotics – a provider must sign an agreement saying they will abide by the program’s laws and regulations, including an anti-kickback statute, only submit claims for medically necessary prescriptions, document requests for Covid-19 tests, and attest that they will not present false or fraudulent claims.

There are similar requirements under the Railroad Retirement Board, which provides benefits to railroad workers, and the VA.

But according to the charging document, from January 2022 to July 2023, Dean and the unnamed co-conspirators devised a scheme in which Dean worked as an independent contractor for the two others and signed doctors’ orders for durable medical equipment and Covid-19 tests “that were used to submit false and fraudulent claims to government health care programs.”

The two others would send Dean an unsigned prescription for the durable medical equipment, which he would electronically sign without seeing or communicating with the patients, according to the documents. That included a certification saying Dean had personally assessed the patient and found the prescription was “medically necessary.”

For Covid-19 tests, Dean signed documents allowing the two others to order the over-the-counter Covid-19 tests in Dean’s name, according to the filings. The others billed the government programs for the tests, which weren’t requested by patients. The court filing says payments for those tests then went to Dean, and he would send most of the money back to the two others.

“Person A and Person B, through Company A and Company B, paid illegal kickbacks and bribes to the defendant in exchange for signing doctors’ orders for DME and over-the-counter Covid-19 tests,” the charging document says. “The defendant used a personal bank account at First Interstate Bank for the purpose of, among other things, receiving illegal kickbacks and bribes from Company A and Company B in exchange for signing doctors’ orders for DME and over-the-counter Covid tests.”

Under the plea agreement with the government, if a judge signs off on it, the U.S. Attorney’s Office would recommend decreases in Dean’s offense level for accepting responsibility. The agreement says Dean had agreed to work with the government and maintains he “can provide substantial assistance” in other ongoing investigations – information which the government agreed not to use against him.

The U.S. Attorney’s Office for the District of Montana said it could not comment further on pending litigation and cases when asked about the two unnamed co-conspirators and if they had been charged.

The plea agreement also says the government will not seek detention for Dean in the case but will defer to the court on that question. He will, under the agreement, have to pay the roughly $708,000 in restitution – most of that going to Medicare.

Ten days before he is sentenced, Dean will have to deliver a $250,000 deposit of that money to the court, according to the agreement.

The charge that Dean agreed to plead guilty to was conspiracy to commit wire fraud, which carries a maximum punishment of up to 20 years in prison, a $250,000 fine and three years of supervised release.

Dean is listed as an emergency department physician at St. Luke Community Healthcare in Ronan on the hospital’s website. Steve Todd, the chief executive officer for St. Luke, said Tuesday afternoon the charges were new information to the company and were not related to Dean’s work as a contracted emergency physician in Ronan.

Todd said the company would investigate the allegations but would keep employment matters confidential.

A WebMD profile of Dean includes 10 one-star reviews, most of which were left last summer and fall and say they believe Dean is running a Medicare billing scam by prescribing medical equipment for which they did not ask.

Blair Miller is a Helena-based reporter. The Daily Montanan is a nonprofit newsroom.