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Physician Conviction for Medicare Fraud upheld for billing

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The United States Sixth Circuit Court of Appeals upheld the conviction of a physician in connection with a scheme to defraud Medicare by billing for infusion therapy treatments that were not needed or not provided as billed.

Defendant Dr. Toe Myint worked as a physician at Sacred Hope Center Inc., a clinic in Southfield, MI, that purported to provide injection therapy to high-risk patients, such as those with HIV or Hepatitis C.

According to the opinion, defendant was hired by the owners and operators of the clinic, who also were indicted in connection with the scheme, so they could use his provider number to bill Medicare, while paying patients to come to the clinic who did not need injection therapy and then administering only a fraction of the drugs billed to Medicare.

A jury convicted defendant of one count of conspiracy to commit Medicare fraud, but acquitted on three counts of defrauding Medicare. The district court sentenced defendant to six years in prison.

Defendant argued, among other things, he was unaware of the clinic’s billing process; did not know the patients were being paid to attend Sacred Hope; did not know the actual amounts of medications administered to patients; and the clinic operators intended to keep him ignorant of the scheme.

The appeals court said the main issue was whether defendant knew the essential purpose of the conspiracy and voluntarily went along with it; direct evidence that he knew of the conspiracy was not necessary for a conviction.