A Little Rock doctor must serve two years in prison and pay more than $700,000 in restitution to insurers and patients after turning a blind eye to regulations that forbid billing massage therapy services as actual "physical therapy," a judge decided Monday.
Dr. Robert Barrow, 62, who from 2003 through 2014 operated a west Little Rock clinic called Your Doctor's Office with his wife, Dr. Angela Barrow, pleaded guilty Oct. 13 to a charge of health care fraud conspiracy. He acknowledged then that he had been "deliberately ignorant" to the fact that his office used a billing code for physical therapy services to seek more than $2.2 million in a seven-year period for services that usually aren't even covered by insurance companies.
Federal prosecutors say Barrow was more than deliberately ignorant, however. They contend that from Sept. 30, 2005, through July 8, 2012, he had money rather than patients on his mind as he contracted with two massage therapists in a row to share space in his clinic at Autumn Road and Chenal Parkway. In return for low rent and overhead expenses, the therapists agreed to give Barrow a percentage of the profits from the services they performed on patients he referred for "physical therapy."
After an investigation sparked by a QualChoice insurance employee who was astounded that a small "mom and pop" clinic on Chenal was the second-highest biller of physical therapy services in the state, surpassing clinics that specialize in rehabilitative and physical therapy services, FBI agents began interviewing patients at the clinic. They discovered that the patients believed they had been receiving -- and paying for -- physical therapy.
In letters to U.S. District Judge Leon Holmes, some of those patients said they wondered why their conditions never improved. Some wondered whether they would still be suffering from the condition years later had they received true physical therapy services at the time.
Holmes said one woman wrote that she "never would have undressed and let him put his hands on me" if she knew the man massaging her wasn't a physical therapist, and that the experience left her feeling "violated."
After the original massage therapist left the clinic in 2005, Barrow contracted with a second person, Billy Marc Young, to continue the day-to-day procedures in which the clinic billed for Young's therapy services under Barrow's provider number using Current Procedural Terminology codes that health insurers interpreted as physical therapy services, according to testimony and court documents. This was despite a letter that Blue Cross and Blue Shield had sent to Barrow in October 2003 questioning repeated bills for physical therapy for one patient over a period of months, to which it received confirmation from Barrow that the patient "has been seen in my office for physical therapy."
While Barrow maintained that the billing errors were the fault of his staff, and said he simply didn't understand the billing codes or regulations, he acknowledged to Holmes that he didn't regularly review the therapists' records to ensure patients were being properly treated and progressing.
The improper billings prompted some concerned clinic staff members to question Barrow, but he rebuffed them, reminding them that he was both a doctor and a lawyer, Assistant U.S. Attorney Alex Morgan told Holmes.
Morgan asked Holmes to impose a sentence of 36 to 46 months, as recommended by federal sentencing guidelines, while defense attorney Erin Cassinelli sought a strictly probationary sentence. Barrow himself, whose wife's charge was dismissed in exchange for his guilty plea, tearfully said from a courtroom lectern, "I failed my patients, my family, my staff and my clinic. ... I'm humiliated that I've lost everything I've worked for" because of "my arrogant innocence."
Barrow's medical license was suspended after he pleaded guilty.
Holmes settled on two years in prison, followed by three years' probation, saying prosecutors hadn't demonstrated beyond a reasonable doubt that Barrow was guilty of deliberate ignorance until June 2011, when QualChoice "put him on notice that criminal activity was probably afoot," and he didn't change his practices. Holmes also acknowledged that during part of the time that prosecutors say Barrow engaged in a fraudulent conspiracy, regulations were in flux and a Blue Cross representative had given Barrow's office the impression it could bill under the codes it used, as long as the therapy was "incidental to" a physician's services.
But Holmes said there came a point when Barrow clearly knew there was a billing problem and didn't correct the situation. He cited the need to deter other providers from improper billing as a strong factor in his decision to send Barrow to prison. He cited letters from health insurers and Medicare about the difficulty of detecting health care fraud with the volume of claims that are processed daily.
"It's an honor system, dependent in large part on the honesty and faith of the providers," the judge said.
In addition to ordering Barrow to repay $702,361.12 to Blue Cross and Medicare for the false billings, Holmes said Barrow must pay an unspecified amount of restitution to patients who are named in a sealed exhibit.
Young pleaded guilty in April 2014 to a charge of making a false statement in relation to health care matters, and agreed to forfeit his interest in the $311,129.59 in proceeds he received through the fraudulent billings. He was sentenced Dec. 17 to a year and a day in prison.
Metro on 07/26/2016
Print Headline: Doctor receives 2 years for fraud against insurers