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Ohio doctor heads million-dollar scam for fraudulent billing

On Behalf of | Feb 23, 2022 | Medical Malpractice, Misdiagnosis |

Medical doctors are bound to the Hippocratic Oath, which is an ancient and sacrosanct ethical code. This oath is supported by a variety of medical malpractice laws that have real consequences for the doctors, medical staff and medical providers.

So, it was no surprise when the U.S. Attorney for the Southern District of Ohio ruled that three medical providers here in Ohio must pay $3 million for submitting improper Medicare and the state’s Bureau of Workers’ Compensation (BWC).

Doctor singled out

The three related settlements involved Orthopedic & Neurological Consultants, New Albany Surgery Center, and Mount Carmel Health System, but Dr. Robert Nowinski was singled out. The part-owner of the Orthopedic & Neurological Consultants was guilty of routinely billing Medicaid and BWC for complex shoulder surgeries that either did not occur or did not require the same standard of care (and thus less expensive) as the surgery he billed. The doctor, now deceased, spent a fraction of the time conducting the surgeries in the operating room than official procedures he billed.

Medical providers are also guilty

Some of these surgeries took place in the ORs of New Albany Surgery Center, which is a joint venture between OrthoNeuro and Mount Carmel Health. Others took place at New Albany Surgical Hospital. Not guilty of knowingly charging fraudulent facilities fees, the service providers were nonetheless responsible for billing fraudulent OR time for the alleged surgeries because they should have received notice for the improper billing. They were ordered to repay the following amounts:

  • OrthoNeuro will pay $498,182 to Medicare and $533,482 to BWC
  • NASC will pay $772,650 to Medicare and $468,406 to BWC
  • Mount Carmel will pay $760,901 to Medicare and $156,139 to BWC

Fake surgeries and fraud

In essence, the doctor and providers were stealing from a state and a federal bureau, which are government agencies owned by the people. Of course, the list of victims also extends to the patients who endured these fraudulent procedures.