A Texas physician could face up to 20 years in prison for pleading guilty to a charge related to kickbacks from Medicare fraud.
Meanwhile, a New York physician will pay $900,000 to resolve civil claims for up-coding billings for medical services including smoking cessation counseling services that were improperly documented, and alleged improper opioid prescriptions.
The U.S. Department of Justice (DOJ), the U.S. Attorney’s Office for the Northern District of New York, and New York Attorney General Letitia James published news releases about the unrelated cases.
Criminal charges
In the criminal case, Daniel R. Canchola, 49, of Flower Mound, Texas, received $466,000 for electronically signing orders for durable medical equipment (DME) and cancer genetic testing. Canchola knew the orders “were used to submit more than $54 million in false and fraudulent claims to Medicare,” according to a DOJ news release.
From August 2018 to April 2019, Canchola received about $30 for each doctor’s order he signed for the unneeded medical equipment and cancer tests. “The Medicare beneficiaries for whom Canchola prescribed DME and cancer genetic testing were targeted by telemarketing campaigns and at health fairs and were induced to submit to the cancer genetic testing and to receive the DME regardless of medical necessity,” according to DOJ.
Canchola pleaded guilty to conspiracy to commit wire fraud and is scheduled to be sentenced on March 15, 2023, according to DOJ.