Monday, December 1, 2008

3 doctors sentenced to prison in health care fraud

ATLANTA (AP) An orthopedic surgeon and two chiropractors were sentenced Thursday to federal prison for cheating insurance companies out of $3 million by mislabeling treatments for back pain.

The sentences are the latest in Georgia to result from a back pain treatment known as Vertebral Axial Decompression.

The U.S. Attorney's Office said Dr. Howard Berkowitz, 58, of Atlanta was sentenced Thursday to 18 months, and the chiropractors, 67-year-old Arthur Hargraves of Douglasville, Ga., and 52-year-old Daniel Puffenberger of Kissimmee, Fla., each got three years and five months.

Berkowitz pleaded guilty and testified against his former partners in the Associated Spinal Care Network, which operated clinics in north Georgia and Tennessee. Prosecutors said the network faked reports to be reimbursed by Blue Cross/Blue Shield of Georgia for the Vax-D procedure, which was not covered by the insurance company.

VAX-D is a non-invasive treatment that uses a mechanical table to stretch a patient's spine. Blue Cross/Blue Shield of Georgia considered it investigational and not medically necessary, and made clear to health care providers that it did not cover the procedure.

The three men were convicted of using a different billing code that pertained to surgical nerve decompression, instead of the specific code assigned to VAX-D, to bill the company for more than $3 million from 2001 through 2005.

On Nov. 10, a federal jury in Atlanta convicted another chiropractor of a similar scheme. His two partners had already pleaded guilty. Another man pleaded guilty in 2005 to the same scheme at clinics in Albany and Columbus, Ga.

In the Northern District of Georgia, seven medical professionals have been convicted, and five were sentenced to a total of over 14 years in prison with monetary judgments topping $7 million.


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