Alleged fake doctor accused of health insurance fraud in Atlanta

A 29-year-old Nashville man has been indicted by a federal grand jury in Atlanta for insurance fraud, Medicare and Medicaid fraud, and other crimes for impersonating a doctor and for persuading doctors in both Georgia in Tennessee to help him falsely bill Medicare, Medicaid and private insurance companies for medical services. He is said to have treated more than 1,000 patients and obtained $1.2 million from the insurers, which was split with other doctors.

The man, who is not a licensed physician in either Georgia or Tennessee, appeared before a federal judge in Atlanta on Wednesday. He faces federal charges of health insurance fraud and wrongfully disclosing private health information for personal gain — 18 counts in total.

Prosecutors accuse man of persuading other doctors to use their own provider IDs to bill for allergy treatment services

The alleged insurance fraud conspiracy involved, oddly enough, allergy treatment services. According to federal prosecutors, the man worked with numerous doctors in both Nashville and Atlanta, who allowed him to provide allergy services through their offices and at health fairs. In exchange for the use of their provider identification numbers, which are required on all insurance claims, the man is said to have given the other doctors between 15 and 50 percent of what he earned.

If the allegations are true, the white collar crime scheme was quite lucrative. Between November 2009 and April 5 of this year, the group apparently earned a total of $1.2 million in insurance billings.

It is not clear whether other individuals will be charged as part of the alleged insurance fraud conspiracy, and no information was released as to exactly what the man said that led people to believe he was a licensed physician or convinced the other doctors to participate in the unusual arrangement. One would not expect allergy treatments to raise many red flags for insurers or prosecutors — or to be the first choice for those interested in pursuing a fraud conspiracy.

If convicted on the unlikely scheme, the man could face up to 10 years in prison and a $250,000 fine for each count.

Source: The Tennessean, “Nashville man charged in Atlanta with impersonating doctor,” Brandon Gee, April 21, 2011