One way for the government to build a case against someone is by issuing a subpoena for records and seeing whether the business or person responding produces record that are false or misleading. This allows the government to not have to prove fraud or other criminal acts.
On July 13, 2018, Dr. Vidal Sheen of St. Louis County, Missouri pled guilty to
obstructing an investigation by the Federal Bureau of Investigation (“FBI”)
regarding whether he billed the Medicare program and private insurers for “face
to face” office visits performed on dates when he was actually traveling
outside of Missouri, and sometimes traveling outside of the United States.
According
to his plea agreement, Dr. Sheen operated a medical office in St. Louis County,
Missouri. At the medical office, Dr. Sheen created medical records using
a template that recited patients’ symptoms and histories, and sometimes
recorded vital signs (e.g. pulse rates) that did not change between patients’
visits.
Moreover,
from time to time, Dr. Sheen traveled to various destinations, including the Dominican Republic and Florida. For the times when Dr.
Sheen was out of town, the government alleged he created office notes with false entries reflecting
that he had seen patients in his office, using his electronic signature.
Dr. Sheen's medical records did not discuss the role of the other employees in
his office during the out-of-town visits, or his absence from the office on the
dates of service.
The
United States served Dr. Sheen’s office with a subpoena requesting medical
records regarding his office visits in late 2016. In response to the
subpoena, on December 1, 2016, Dr. Sheen produced medical
records to the FBI in which he had made entries about face-to-face office
visits when he was out of town.
The government alleged that these entries and producing these records without indicating that he was out of town or that others saw the patients was done in an effort to impede, obstruct, and influence the FBI’s billing
investigation.
Dr.
Sheen pled guilty to one felony count of obstructing an investigation before
United States District Judge Audrey G. Fleissig. Sentencing has been set
for October 23, 2018.
In determining the actual
sentences, a Judge is required to consider the U.S. Sentencing Guidelines,
which provide recommended sentencing ranges.
Attorney Commentary: It may have been that the obstruction charge was a negotiated plea since a professional may prefer a count that does not have "fraud" as one of its elements in order to avoid other collateral consequences such as a medical license.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
