Federal prosecutors have focused investigations on the billing of labor union members’ health benefit plans especially in places like San Francisco where workers have generous union contracts. A recent case illustrates the types of cases that are being prosecuted.
December 6, 2019, acupuncturist Haichao Huang pleaded guilty to health care fraud, in violation of 18 U.S.C. § 1347, and making false statements relating to health care matters, in violation of 18 U.S.C. § 1035(a)(2), in the
Northern District of California. The guilty plea was accepted by the Honorable
Susan Illston, U.S. District Judge.
According
to the plea agreement, Mr. Huang was a health care provider
who offered acupuncture, physical therapy, massage, and other services to
patients in and around San Francisco. From February
2013 through June 2018, Mr. Huang admitted that he submitted and
caused to be submitted false claims for reimbursement from health care benefit
programs that he knew were not properly payable, including from programs
provided through federal government and labor union healthcare plans.
Mr. Huang's plea admits that he included false and inaccurate billing codes that artificially inflated both the
type of service the patient received and the time he spent with the patient.
The plea agreement gives examples of the ways in which Mr. Huang submitted false
and inaccurate billings for reimbursement. For example, Mr. Huang submitted requests for
reimbursement for acupuncture treatment when, in fact, the patient had received
much shorter periods of treatment, no acupuncture treatment, or no care of any
kind at all.
Mr. Huang also submitted claims for services rendered on days when
patients had not been seen by him at all—including days when Mr. Huang was not in
California. Further, after a patient reached the limit of acupuncture sessions
allowed by the relevant insurance program or plan, Mr. Huang falsely and
inaccurately billed for other types of treatments and services that were not
provided, or billed under a patient’s family member’s health plan who never
received treatment through his practice, in order to continue receiving
improper reimbursements. Where there is billing of the family member's plan after benefits have been exhausted it is usually at the request of the family member but it is still not allowed.
Pursuant to the terms of
his plea agreement, Mr. Huang has agreed to pay restitution in an amount to be set
by the court at the time of sentencing, but in no event less than $807,785.38.
Judge Illston scheduled the sentencing hearing for March 13, 2020.
In addition
to restitution, Mr.Huang faces a maximum statutory sentence of 10 years in
prison and $250,000 for each violation of 18 U.S.C. § 1347. Further, Mr. Huang faces up to five years in prison and a fine of $250,000 for the
violation of 18 U.S.C. § 1035(a)(2). Imposition of a fine depends on the defendant's ability to pay and finances.
The court also may order additional fines
and additional periods of supervised release at sentencing. However, any
sentence following conviction will be imposed by the court only after
consideration of the U.S. Sentencing Guidelines and the federal statute
governing the
imposition of a sentence, 18 U.S.C. § 3553. Payment of restitution prior to sentencing can help Mr. Huang receive a lower sentence since it will show further acceptance of responsibility.
Posted by Tracy Green
the imposition of a sentence, 18 U.S.C. § 3553.
