10 indicted in $300M healthcare kickback scheme; founders of North Texas companies accused
A federal grand jury has indicted 10 people including two medical doctors in a $300 million healthcare fraud case, federal authorities said Thursday.
According to the indictment, the founders of several lab companies, including Unified Laboratory Services in Fort Worth, Spectrum Diagnostic Laboratory in Arlington, and Reliable Labs LLC in Carrollton, allegedly paid kickbacks to induce medical professionals to order medically unnecessary lab tests, which they then billed to Medicare and other federal healthcare programs.
Federal authorities said internal medicine specialist Dr. Eduardo Canova in Laredo, family medicine practitioner Dr. Jose Maldonado in Laredo and nurse practitioner Keith Wichinski based in San Antonio are accused of accepting the bribes and ordering millions of dollars’ worth of tests.
Other defendants indicted include:
▪ Jeffrey Paul Madison, founder of Unified Laboratory Services and Spectrum Diagnostic Laboratory
▪ Mark Christopher Boggess, chief operating officer for Spectrum and Unified
▪ Biby Ancy Kurian, co-founder of Reliable Labs LLC
▪ Abraham Phillips, co-founder of Reliable Labs LLC
▪ David Michael Lizcano, owner of DCLH, a marketing firm engaged by Unified, Spectrum, and Reliable
▪ Laura Ortiz, sister of David Lizcano and employee at his marketing firm
▪ Juan David Rojas, owner of Rojas & Associates, another marketing firm engaged by Unified, Spectrum, and Reliable
If convicted, the defendants face a maximum of 55 years or more in a federal prison.
“Anti-kickback laws are designed to ensure that financial considerations do not cloud physicians’ judgment,” said U.S. Attorney for the Northern District of Texas Chad E. Meacham in a Thursday news release. “The Justice Department is determined to prosecute those flouting our nation’s healthcare fraud laws. Patients — and taxpayers — deserve rigorous enforcement.”
The defendants — who stand accused of conspiracy to commit healthcare fraud, conspiracy to pay and receive healthcare kickbacks, offering or paying illegal kickbacks, and soliciting or receiving illegal kickbacks — were charged in a 26-count indictment filed Wednesday afternoon.
The medical professionals were indicted and accused of accepting bribes while the companies disguised the kickbacks as legitimate business transactions, including as medical advisor agreement payments, salary offsets, lease payments, and marketing commissions.
The labs, through marketers, allegedly paid doctors hundreds of thousands of dollars for “advisory services,” which were never performed, in return for lab test referrals.
They also allegedly paid portions of the doctors’ staffs’ salaries and a portion of their office leases, contingent on the number of lab tests they referred each month. In some instances, lab marketers even made direct payments to the provider’s spouse, the release said.
Federal authorities said that when the labs threatened one provider that payments would cease if he didn’t refer more tests, he immediately increased his lab referrals, averaging approximately 20 to 30 referrals per day.
According to court documents, knowing they could disguise additional kickbacks using a provider-ownership model, the founder of Spectrum and Unified, Jeffrey Madison, convinced the co-founders of Reliable, Biby Kurian and Abraham Phillips, to convert Reliable into a physician-owned lab. Reliable offered physicians ownership opportunities only if those physicians referred an adequate number of lab tests. In some cases, they made advance disbursement payment to physicians in an effort to appease the physician and ensure he would not send samples to other labs, according to the indictment.
Laboratories controlled by the defendants were able to submit more than $300 million in billing to federal government healthcare programs, according to federal authorities.
Between 2015 and 2018, Dr. Maldonado alone received more than $400,000 in kickbacks for ordering more than $4 million worth of lab tests and Dr. Canova received more than $300,000 in kickbacks for ordering more than $12 million worth of lab tests, according to the news release.
“Illegal kickback schemes corrupt the healthcare system. They cause billions of dollars in losses each year, generate business for dishonest service providers and erode trust in our health care system,” said Dallas FBI Special Agent in Charge Matthew DeSarno in the news release. “The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes.”
This story was originally published February 10, 2022 at 12:59 PM.
