When seeking reimbursement for medical services, it is important that the service be provided and that it be medically appropriate.  That statement seems to make a lot of sense in theory.  For some reason, healthcare providers have a hard time with applying the statement. A Houston doctor was recently made very familiar with the application of this statement.  In short, do the test or the time, your choice.

A federal jury convicted Dr. Leonard Kibert, 65, and his medical clinic administrator, Tsolak Gevorgyan, 30, of all 41 and 44 counts as charged, respectively, following a three-week trial in February 2016.  At trial, it was determined that all of the Medicare billing for alleged diagnostic testing at the New Life Sleeping & Allergy Disorder Center was fraudulent because the testing either was never performed or was not medically necessary.  Dr. Kibert owned New Life and Mr. Gevorgyan was the manager. Prosecutors introduced evidence that Dr. Kibert and Mr. Gevorgyan filed false claims with Medicare for medical procedures which either were never performed or were not medically necessary.  The conspiracy defrauded Medicare of more than $6.6 million.

Dr. Kibert was the only physician evaluating and treating patients at New Life.  Patients were apparently brought to the clinics by recruiters/marketers who Mr. Gevorgyan paid to bring the patients.  U.S. District Judge Keith P. Ellison, who presided over the trial, sentenced Dr. Kibert to 63 months in prison to be followed by three years of supervised release.  He was further ordered to pay restitution in the amount of $2.89 million.  One of the patient recruiters, Robert Manning, 61, previously pled guilty for his role and was sentenced  to 12 months and one day in prison.  Two others are also pending sentencing.

The Texas Medical Board suspended Dr. Kibert’s license to practice medicine on Aug. 12, 2016, based on his convictions.