According to a federal indictment, Stephen Dubin, MD, allegedly caused more than $95 million in Medicare claims for amniotic wound allografts that prosecutors contend were medically unnecessary, resulting in more than $54 million in Medicare payments.
The indictment alleges that the allografts were used in elderly patients, including some receiving hospice care, and that their use was influenced by illegal kickbacks, bribes, and rebates from distributors. Prosecutors also allege that patient records were falsified to make the procedures appear medically reasonable and compliant with Medicare requirements. The indictment includes one conspiracy charge and five health care fraud counts against Dubin. The indictment is an allegation, and he is presumed innocent unless proven guilty. If convicted, he faces a maximum of 60 years in prison for all charges.
Prosecutors allege that illegal kickbacks, bribes, and rebates led Dubin and his co-conspirators to use allografts in cases that did not satisfy Medicare's medical necessity requirements, including infected wounds, wounds that had not responded to treatment, wounds that had not undergone required conservative care, and in amounts that exceeded wound size. The indictment also alleges that Dubin selected products based on financial return rather than clinical need and falsified patient records to indicate the allograft applications met Medicare requirements.
The charges are the first announced in Nevada since the Justice Department's Fraud Division established the West Coast Health Care Fraud Strike Force, a multidistrict enforcement initiative spanning Arizona, Nevada, and Northern California.
“This indictment exposes a scheme driven by greed, not medicine. As alleged, this provider exploited elderly patients by pushing costly and unnecessary medical procedures, then lied to Medicare to pocket millions of taxpayer dollars,” said Colin M. McDonald, Assistant Attorney General of the Justice Department’s National Fraud Enforcement Division.
Source: US Department of Justice
