Florida doctor pleads guilty to $2 million Medicare Advantage fraud
Isaac Kojo Anakwah Thompson falsely diagnosed rare spinal disease in close to 400 patients to obtain 80 percent of capitated payments
A Florida doctor who falsely diagnosed hundreds of patients as having a rare spine condition, has pleaded guilty to healthcare fraud and faces spending a decade in prison.
Isaac Kojo Anakwah Thompson, 57, who operated a clinic in Delray Beach, Florida, admitted in court to defrauding the Medicare Advantage program, according to the March 4 statement from the U.S. Attorney's Office, Southern District of Florida.
For each member who enrolls in a Medicare Advantage plan, Medicare pays the sponsoring insurance company a fixed, or capitated, monthly fee based on the beneficiary's medical condition. Medicare generally pays more for a beneficiary with a more serious medical condition, based on the diagnoses submitted by the Medicare Advantage plan physician.
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Thompson, an internist, was a Medicare Advantage plan physician for Humana, according to the U.S. Department of Justice.
Between 2006 and 2010, Thompson diagnosed 387 Medicare Advantage beneficiaries with ankylosing spondylitis, a rare chronic inflammatory disease of the spine, authorities said. All or almost all of the patients had ankylosing spondylitis, authorities said.
Because the diagnoses were false, Thompson did not have any corresponding increase in the cost to treat patients.
Thompson reported these diagnoses to Humana's HMO network for Medicare Advantage plans, which in turn reported them to Medicare, according to prosecutors.
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As a result, Medicare paid approximately $2.1 million in excess capitation fees, approximately 80 percent of which went to Thompson, they said.
Thompson is scheduled to be sentenced on May 18 and faces a maximum sentence of 10 years in prison.
"The Medicare system relies on our nation's doctors to diagnose and treat our Medicare beneficiaries," said U.S. Attorney Wifredo A. Ferrer. "When doctors intentionally misdiagnose their patients for personal gain, they betray the trust of the Medicare system and the patients themselves."
Twitter: @SusanJMorse
