Chiropractor who had local office pleads guilty
Published 9:13 am Friday, February 13, 2015
U.S. Attorney Kenneth A. Polite said Covington’s David Lee Killen, 43, recently pled guilty today to a one-count Bill of Information for health care fraud.
Killen admitted to fraudulently billing health care insurance plans for chiropractic and other services that were not rendered or were otherwise unauthorized.
According to court documents, Killen was a chiropractor who owned and operated Back on Track Clinic LLC in Bogalusa, which is no longer operating. Killen billed insurers for chiropractic services, back braces and X-rays that he did not provide.
Killen also billed insurers for an expensive allergy test, the antigen leukocyte antibody test, otherwise known as an “ALCAT.” Killen either did not render the ALCATs or used it to incentivize his patients, bartering for reductions in co-payments or erasing co-payment balances if the patient would agree to the test.
Killen also fraudulently billed insurers for services using physician provider numbers without authorization or on days when the physicians were not working in his clinic.
Killen faces a maximum term of 10 years imprisonment, a fine of $250,000, and three years of supervised release following any term of imprisonment. U.S. District Judge Sarah S. Vance set sentencing for April 29, 2015.
U.S. Attorney Polite praised the work of the Federal Bureau of Investigation, the United States Department of Health and Human Service’s Office of Inspector General for investigating this matter. Special Assistant United States Attorney Juliana A. Etland is in charge of the prosecution.
According to court records, if this matter were to proceed to trial, the government would prove the following facts through competent evidence:
Records provided by the Louisiana Secretary of State would establish that Back on Track Clinic, LLC and The Spine and Joint Center of Washington Parish listed Killen as the Manager and Registered Agent.
A witness from the Louisiana State Board of Chiropractic Examiners would testify that Killen was a licensed chiropractor in Louisiana from on or about Oct. 31, 2006 until on or about Dec. 31, 2012.
Witnesses from Blue Cross Blue Shield of Louisiana, United Health Care, Cigna, Humana, Louisiana Medicaid and Gilsbar would testify that Killen and physicians operating in his practice, were authorized to provide certain services and equipment to covered beneficiaries.
A witness from a health care benefit plan (would testify that suppliers such as Killen were required to accurately describe equipment being provided to patients using the Healthcare Common Procedure Coding Systems code. The witness would describe HCPCS L0631 as a back brace entitled “Lumbar-Sacral Orthosis” and testify that it would be required to extend from the “Sacrococcygeal Junction to T-9 Vertebra.” The witness would also describe HCPCS L0627 as a back brace entitled “Lumbar Orthosis” that would be required to extend from “L-1 to below L-5 Vertebra.” The witness would testify that HCBPs paid higher reimbursements for HCPCS L0631 than L0627 because L0631 was required to cover a larger area of the back vertebra.
The witness would also testify that claims submitted to HCBPs by Killen were generally paid at 80 percent of the pre-approved contracted amount for each claim. The witness would testify that unless a beneficiary held secondary or supplemental insurance, the beneficiary was responsible for paying the remaining 20 percent of the claim, known as the co-insurance. The witness would testify that this co-insurance could not generally be waived.
Krista Bradford, a special agent with the FBI would testify that she, along with FBI special agents, and the US Department of Health and Human Services Office of Inspector General, executed a federal search warrant on Killen’s chiropractic office on April 26, 2013. Bradford would testify that Killen’s computer records were imaged, and that other original patient records were seized.
Bradford would testify that during her investigation into Killen’s practice, she interviewed patients, interviewed office staff, and reviewed records seized during the search warrant. Based on her investigation, Bradford would testify that she identified several patients who claimed not to have received services billed on their behalf, and others who claimed they did not receive durable medical equipment billed on their behalf. Bradford would testify that she identified the following billing schemes in his practice during her investigation:
• Billing for chiropractic manipulation that was not performed.
• Billing for ALCATs that were not performed.
• Incentivized ALCATS: Bradford identified instances where Killen offered incentives to patients to receive the ALCAT, that Killen routinely ordered and billed the most expensive test that Cell Science offered, and that there was no documentation to show the patient’s need for the test.
• Unauthorized use of physician provider numbers.
•Billing for X-rays not performed.
• Billing for L0631 back braces that were not provided.
• Billing for L0631 back braces, but providing a cheaper substitution.
Bradford would testify that she identified approximately $285,234 in billings for the schemes, and of that amount, Killen was paid approximately $183,674.14.