Incident-to Violation Leads to Guilty Plea in $2.2M Fraud Case

Incident-to Violation Leads to Guilty Plea in $2.2M Fraud Case

By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA
Christopher R. Thyer, United States Attorney for the Eastern District of Arkansas, David Shepard, Assistant Special Agent in Charge for the Little Rock Field Office of the Federal Bureau of Investigation (FBI), and Special Agent in Charge CJ Porter of U.S. Department of Health and Human Services–Office of Inspector General (HHS–OIG) announced that Dr. Robert Barrow, 62, of Little Rock, pled guilty  to conspiring to commit healthcare fraud before U.S. District Court Judge J. Leon Holmes.
Dr. Barrow owned and operated a Little Rock medical clinic named “Your Doctor’s Office.” According to the announcement, Dr. Barrow admitted that he conspired with Billy Marc Young, a local massage therapist. Dr. Barrow referred patients to Young, and Young’s services were subsequently billed to health insurers under Dr. Barrow’s provider number as if they were physical therapy—even at times when Dr. Barrow himself was out of the state or out of the country in places like Las Vegas, Hawaii, and London. Bills to health insurers ultimately surpassed $2.2 million.
The relevant provisions of the incident to rule that were violated were:
1. Dr. Barrow did not provide direct on-premise supervision.
2. The therapist likely did not qualify as “auxiliary personnel,” as defined in the rule.
3. Under the special delegation rule for therapy services, Mr. Young was not a qualified provider relative to physical therapy services.

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Michael Miscoe
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Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.

No Responses to “Incident-to Violation Leads to Guilty Plea in $2.2M Fraud Case”

  1. Susan Garland, CPC says:

    I have read many of your articles on the Incident To subject and would appreciate your thoughts on a situation I am dealing with. We are group of 40 specialists who contract with several local hospitals. We have several employee PAs and complete split/share billing using these assistants without issue. But recently some providers have started using physician assistants who are employees of the hospital to assistant in seeing patients and preparing documentation. The patient notes come to me with the supervising employee signature and the assistant non employee signature. Everything I read from AAPC, Medicare, and other sources states physicians and PAs have to be employees of the same practice for billing purposes. Are you aware of any guideline under which these employee/non employee visits are acceptable or should we put a stop to them immediately? Thank you!

  2. Thelma Stewart says:

    Mr. Miscoe,
    I have a question about incident-to guidelines for mutispecialty practices. I hace seached CMS guidelines and cannot find specific clauses to substantiate statements I have been recently told. Would you please email me at Thank you in advance.

  3. Michael Miscoe says:

    What have you been told?

  4. Michael Miscoe says:

    you are correct. What is going might be okay if the practice is “renting” the PA’s from the hospital. If they are not, there are a multitude of concerns. Not only can their work not be considered in determining the level of E/M due to lack of employment relationship, but the hospital “giving” the practice a free PA would potentially implicate the anti-kickback statute assuming the practice generates referrals to the hospital.