Signs of $14.7 Million Medicare Fraud from Mountain Home Doctor Date Back for Years

by Mark Friedman  on Monday, Mar. 31, 2014 12:00 am  

But the increased billing raised red flags.

An ‘Aberrant’ Biller

In 2006, in an attempt to root out fraud, the Centers for Medicare & Medicaid Services hired AdvanceMed Corp. to analyze Medicare billings by providers in Arkansas, Louisiana and Oklahoma for 2003-05.

The analysis ranked Johnson as the most “aberrant” biller among cardiologists in Arkansas. That sparked a full investigation, which was launched on July 25, 2006.

AdvanceMed’s yearlong review found problems with more than 90 percent of his billing.

It said Johnson performed 115 unnecessary heart catheterizations between 2004 and June 30, 2006. Nearly 80 percent of the 822 claims he submitted during that period were denied because the documentation didn’t support the medical need for the procedure billed.

AdvanceMed wasn’t alone in its analysis. In 2007, Pinnacle Business Solutions Inc., which is contracted by CMS to pay Medicare claims, became alarmed by Dr. Johnson’s claims, finding that between April and September 2006, he was the No. 1 biller in the country for two procedures involving catheter placements.

Those findings were forwarded to the Office of the Inspector General for the U.S. Department of Health & Human Services, which started an investigation in August 2008 and found even more questionable billings, Kowalski’s affidavit said. After looking at the periods between Jan. 1, 2004, and June 30, 2006, and Jan. 1, 2007, through June 26, 2009, “an established Medicare overpayment to Johnson was calculated as” $14.7 million, Kowalski’s affidavit said.

A U.S. attorney — Kowalski’s affidavit didn’t say which one — hired Dr. Maan Jokhadar of Atlanta to look over the medical records of six of Johnson’s patients.

Jokhadar found “Dr. Johnson’s documentation was voluminous, repetitious and overall poor in quality,” Kowalski wrote. “Documentation focused on patients’ social and family situations, and rarely elaborated on symptoms or complaints presented by the patients.”

Jokhadar also found that Johnson ordered a number of tests that weren’t medically necessary, while other tests were just duplicates of previous tests.

Meanwhile, patient complaints were stacking up against Johnson at the state Medical Board. And his marriage to Cynthia was falling apart. She told Arkansas Business that he left her for a younger woman. He fired Cynthia from her job at his practice and filed for divorce on the same day, Jan. 13, 2009.

 

 

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